The profile of the overdose patient presenting at Paarl Hospital Emergency Department

Abstract

BackgroundOverdose is a common problem often seen in emergency departments in South Africa. A subjective evaluation by doctors and nurses at Paarl Hospital indicated that there was a high incidence of patients who had overdosed presenting at this hospital. They found this distressing and felt that there should be an enquiry into the phenomenon. The aim of this study was to determine the profile of the overdose patient presenting at Paarl Hospital, the number of cases per day of the week and per month of the year, which drugs were used most commonly, as well as the seriousness of the incident. The study also looked at whether the hospital's policy regarding psychiatric evaluation protocol was being followed. Finally, some recommendations were made concerning possible intervention efforts. MethodsA review was done of cases involving all patients with overdoses presenting at Paarl Hospital during the period 1 July to 31 December 2005. Data was collected from 196 medical records using a data collection form. ResultsThe frequency of overdoses at Paarl Hospital was found to be 1.13 cases per day. The results of the study showed that most patients were females with an average age of 27.3 years. Most patients were either unemployed or scholars from low socio-economic circumstances. Tricyclic antidepressants and paracetamol were the drugs used most commonly and 42.3% of the patients took more than one drug. Few cases of overdose resulted in serious morbidity, with only 8.5% admitted to high care. In most cases the attending doctors followed the policy of the hospital regarding psychiatric evaluation. ConclusionPossible preventative interventions should focus on educational initiatives in communities. Patients should be educated about the dangers of their medication and that all medication should be kept out of reach of children and preferably be locked away. Doctors should take note of the drugs most commonly used for overdosing and should be more cautious when prescribing these drugs. It is preferred that patients be seen by the social worker before being discharged, since there is no control over whether the patient will keep his/her appointment at the day hospital. The social worker should be adequately trained to identify patients needing psychiatric evaluation and be able to refer them to the appropriate mental healthcare practitioner. SA Fam Pract 2007;49(2):16The full version of this article is available at: www.safpj.co.za P This article has been peer reviewed Original Research

The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa

“…Paracetamol is worldwide one of the most frequently used drugs associated with toxicology-related morbidity and mortality [19] , [20] . The prevalence of intentional paracetamol overdose in Khayelitsha Hospital (25%) is comparable to the limited reported prevalence in other South African state institutions (20–27%) [11] , [21] , [22] , and might justify why 78% of patients in the resuscitation unit had a paracetamol level done as part of their diagnostic work-up. International toxicology experts point out that the high-risk to the patient (patients are often completely asymptomatic until after irreversible liver damage has occurred) as well as the relative low cost of the test far outweighs the impact of liver failure and possible death if paracetamol toxicity are missed [23] .…”

The profile of deliberate self-poisoning cases presenting at the emergency department of Pelonomi Regional Hospital, Bloemfontein

“…23 Similar results were found in the Western Cape where the highest number of overdose cases per square kilometre occurred in an informal settlement with a high density of people and very poor socioeconomic circumstances. 12 The highest percentages of patients presented with DSP between February 2010 and April 2010. Stark et al 2 reported that the majority of suicide cases occurred during the first four months of the year.…”

“…The high incidence of DSP among females, as shown in this study, is similar to studies done internationally 15,[17][18][19] and nationally. 5,12 Women are more prone to DSP while men generally attempt suicide by means of more violent methods, such as hanging or self-inflicted gunshot. 5 Successful suicide may be the reason why men are underrepresented in DSP statistics.…”

“…2 More studies should be conducted on this subject in South Africa, owing to its common occurrence and the high cost required in its management. 12,14,15 A study on self-poisoning by pesticide has shown that most patients reach the hospital alive 7 -the survival of such patients, therefore, to a large extent depends on the competence of the attending doctors and other health professionals in the emergency department. Thus, inadequate research into DSP may lead to poor knowledge of health professionals on the approach to victims of DSP and this may result in a poor outcome.…”

The economic burden of deliberate self-poisoning: insight from a tertiary hospital in the Free State Province, South Africa

“…Deliberate self-poisoning (DSP), a common method of suicide, is the intentional ingestion of substances never intended for human consumption or of more than a prescribed amount of medicinal substances, whether or not there is evidence that the act was intended to result in death [ 1 ]. The global incidence of DSP has been estimated to be between 0.4% to 10% [ 2 ], affecting more females than males [ 3 - 5 ] and occurring in any person in the age range 20-30 years [ 6 , 7 ]. Similarly, in South Africa, between 9.5% and 11% of all non-natural deaths are suicide related [ 8 ], and intentional self-harm ranked 6 th amongst the causes of non-natural deaths thus, accounting for 0.8% of non-natural deaths and 0.1% of all causes of death in the year 2016 [ 9 ].…”