Abstract
Objectives
Changes in poisoning trends may affect both complications and outcomes in patients with acute poisoning. This study reports the treatments given and the frequency of complications, also related to treatment, mortality and sequelae related to various toxic agents.
Methods
All acute poisonings in adults (≥16 years) admitted to the five hospitals in Oslo were included consecutively during one year (2008 to 2009) in an observational cross-sectional multicenter study. A standardized form was completed by the treating physician, which covered the study aims.
Results
There were 1065 admissions in 912 patients. The median length of hospital stay was one day, and 49% were observed in an intensive care unit (ICU). Active treatment was given to 83%, and consisted of supportive therapy (70%), antidote(s) (38%), activated charcoal (16%) and gastric lavage (9%). The most commonly used antidotes were flumazenil (19%), naloxone (17%) and N-acetylcysteine (11%). The rate of treatment-related complications was 2.4% (21/884). Neither flumazenil, naloxone, nor the combination, was associated with convulsions or other complications. Among those receiving N-acetylcysteine, 5% (6/120) developed allergic reactions, one of which mandated discontinuation of treatment. Nineteen percent presented in a coma. Complications developed in 30%, compared with 18% in a 2003 study, mainly respiratory depression (12%), prolonged QTc interval (6%) and hypotension (5%). Eight patients died (0.8%) and five (0.5%) survived with permanent sequelae, mainly anoxic brain damage.
Discussion
Few patients stayed more than two days. The use of the ICU was liberal, considering that only one out of five presented in a coma. Antidotes were frequently given diagnostically. Although N-acetylcysteine induced allergic reactions, most were mild and treatment discontinuation was only necessary once. The frequency of complications had almost doubled in five years, although the poisoning pattern was largely unchanged. However, few patients developed permanent sequelae.
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Details
1 Oslo University Hospital Ullevaal, Department of Acute Medicine, Oslo, Norway (GRID:grid.55325.34) (ISNI:0000000403898485)
2 Lovisenberg Hospital, Department of Acute Medicine, Oslo, Norway (GRID:grid.416137.6) (ISNI:0000000406273157)
3 Diakonhjemmet Hospital, Department of Medicine, Oslo, Norway (GRID:grid.413684.c) (ISNI:0000000405128628)
4 Oslo University Hospital Aker, Department of Medicine, Oslo, Norway (GRID:grid.55325.34) (ISNI:0000000403898485)
5 Akershus University Hospital, Department of Medicine, Nordbyhagen, Norway (GRID:grid.411279.8)
6 Oslo University Hospital Ullevaal, The National Center for NBC Medicine, Department of Acute Medicine, Oslo, Norwayd (GRID:grid.55325.34) (ISNI:0000000403898485)