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Misuse/abuse of pregabalin is increasing worldwide. French Poison Control Centers (PCCs) recently received several unusual calls regarding the recreational use of pregabalin in adolescents. This study aims to describe this new and specific population of pregabalin misusers.We extracted all cases of pregabalin intentional exposures reported to the French National Database of Poisonings (FNDP) from 2004 to 2020. We compared the proportion of recreational exposure to pregabalin between adolescents (10-17 years) and adults (18 years). We reviewed all cases of pregabalin recreational exposures in adolescent in order to describe the characteristics of this population.During the study period, 382 cases of acute intentional exposure to pregabalin were reported in adolescents and 1188 in adults, 94/382 (24.6%) and 43/1188 (3.6%) were pregabalin recreational use, respectively (We observed a sharp increase in pregabalin recreational use in adolescents in France. It should lead to prevention campaigns, targeted at the population at risk described in this study.

In France, 57 species of scorpions are described with a limited number of clinical studies. In this article, we report the epidemiology of scorpion sting events in mainland France and its overseas territories based on cases reported to the French poison-control centres (FPCC).This retrospective multicentre study was conducted with data from FPCC's files about scorpion stings between January 1, 2011 and December 31, 2020.Among 975 recorded files, 624 patients were included because they were stung by scorpions native to French territories. Most stings occurred along the Mediterranean coast in summer and indoors (in persons' homes) during the daytime. The scorpions were identified in 50% of cases. According to signs of envenoming, patients were divided into class III (2 cases; 1%), class II (51 cases; 8%), class I (444 cases; 71%) and asymptomatic stings (127 cases; 20%). Twelve pregnant women were stung and two of them had contractions, which triggered childbirth in one woman. Ten patients had local infections in the first week after the sting. One patient had venous thrombosis 2 days after the sting. Life-threatening scorpions, i.e.,Scorpion stings in French territories are frequently on the Mediterranean coast and French Guiana. Life-threatening cases are limited to

Resume Le datura est une plante largement repandue a travers le monde et connue depuis des siecles pour ses proprietes pharmacologiques, toxiques et hallucinogenes dues aux alcaloides tropaniques qu’elle contient (atropine, scopolamine et hyoscyamine). Ces derniers ont des effets parasympathicolytiques et leur consommation peut entrainer un syndrome anticholinergique. En France, le datura est present dans certains jardins comme plante d’agrement mais egalement a l’etat sauvage, dans les zones rurales et urbaines. Les intoxications alimentaires accidentelles liees au datura sont assez frequentes du fait de sa ressemblance avec d’autres plantes, notamment avec l’epinard. Nous rapportons ici une serie de cas d’intoxications accidentelles au datura a la suite d’un repas familial, avec confirmation analytique de la presence d’atropine et de scopolamine pour deux des patients et dans un echantillon du repas.

Context: Today, immunotherapy with Fab or F(ab′)2 fragments is considered as a gold standard treatment for patients bitten by vipers. We compared the efficiency of two antivenoms, Viperfav® and Vip...

Resume L’acide γ-amino-butyrique (GABA), principal neurotransmetteur inhibiteur du systeme nerveux central, se lie aux recepteurs GABAA et GABAB. Les intoxications aigues par les agonistes des recepteurs GABAA (ethanol, benzodiazepines) sont tres frequentes et peuvent entrainer un coma calme et hypotonique. Le traitement du coma ethylique est symptomatique alors qu’il existe un antidote pour les intoxications par benzodiazepines, le flumazenil. Les intoxications par les agonistes des recepteurs GABAB (GHB, baclofene) sont rares mais en augmentation. Les intoxications par GHB peuvent entrainer un coma calme hypotonique associe a une bradycardie, une depression respiratoire et des myoclonies. Les intoxications par baclofene peuvent entrainer des troubles neurologiques parfois associes a des complications respiratoires et hemodynamiques. Dans les deux cas, le traitement est symptomatique. Apres une intoxication aigue par des agonistes GABA, il peut survenir un syndrome de sevrage chez les utilisateurs chroniques peu de temps apres la resolution des symptomes d’intoxication. Les agonistes GABAergiques sont frequemment rencontres au cours des intoxications aigues. Si les intoxications par les agonistes des recepteurs GABAA sont bien connus (ethanol, benzodiazepines), ces vingt dernieres annees ont vu emerger la survenue d’intoxications par les agonistes des recepteurs GABAB (GHB, baclofene).

International audience; Aims: To assess recommendations provided by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup on extracorporeal toxin removal (ECTR) in lithium poisoning.Methods: Retrospective assessment in a 128 lithium-poisoned patient cohort previously used to identify ECTR initiation criteria that could improve outcome (Paris criteria). ECTR requirement using EXTRIP criteria was compared to the actual practice or if Paris criteria were used. The potential impact on outcome if these different criteria were used was investigated.Results: Using the recommended (Rec-EXTRIP) or recommended + suggested (All-EXTRIP) EXTRIP criteria, ECTR would have been indicated in more patients than was actually done (P < .001), or if Paris criteria were used (P < .01). The non-actually ECTR-treated patients fulfilling Rec-EXTRIP or All-EXTRIP criteria had shorter intensive care unit stay (P < .05) and no significant increase in fatalities and neurological impairment on discharge in comparison to the actually ECTR-treated patients. ECTR requirements using EXTRIP vs Paris criteria were not concordant (P < .001). In the non-actually ECTR-treated patients, 31/106 and 55/106 patients fulfilled Rec-EXTRIP or All-EXTRIP but not Paris criteria, respectively. Those patients had longer stay (P < .01) but no worse neurological impairment on discharge than the patients not fulfilling any of these criteria (50/106 and 26/106, respectively). In the non-actually ECTR-treated patients, 7/106 fulfilled Paris but not Rec-EXTRIP criteria. Those patients had longer stay (P < .05) and worse neurological impairment on discharge (P < .01) than the 50/106 patients not fulfilling any of these criteria.Conclusion: In this cohort of lithium poisonings, EXTRIP criteria may lead to more ECTR than actually performed or if the Paris criteria were used, with no demonstrated improvement in outcome.

Resume Depuis les annees 2000, il existe aux Etats-Unis une « crise des opioides ». Cette crise est definie par l’augmentation massive et sans precedent du nombre de deces par overdose d’opioides. La particularite de ces overdoses reside principalement dans l’implication d’opioides prescrits initialement a visee antalgique et secondairement, objet de mesusage, alors que les overdoses des annees 80–90 impliquaient majoritairement l’heroine. Ce phenomene a pour genese differents facteurs, pour la plupart non limites au seul territoire americain, qui se sont deroules dans les annees 90 et qui ont conduit a une prescription large des opioides dans les douleurs non cancereuses. En Europe et en France, on observe egalement, mais dans une bien moindre mesure, une augmentation de la consommation des opioides forts et de la morbi-mortalite liee a leur prescription. Cette situation que l’on peut qualifier de preoccupante aujourd’hui, et non de crise comme aux Etats-Unis, necessite une prise de conscience de tous en amont (prescription rationnelle des opioides) et en aval (savoir reconnaitre et prendre en charge une intoxication par opioides) de la prescription d’opioides.

Contact with the setae of larvae (caterpillars) of pine or oak processionary moths could induce urticarial or allergic reactions in humans. These species are present in France and presently expanding towards highly populated areas due to climate change and/or human-mediated translocations. We aimed to describe the symptomatic cases of exposure to processionary larvae in France.We conducted a retrospective study of symptomatic cases of exposure to processionary larvae registered by the French poison control centres between 1 January 2012 and 31 July 2019. We reviewed all medical records coded with the agent "larvae".Of the 1274 included cases, 59% and 27% corresponded to pine and oak processionary larvae, respectively; the 14% remaining cases concerned unspecified processionary larvae. While the annual number of cases due to pine processionary larvae fluctuated during the study period, cases associated with oak processionary larvae increased steadily. Most of the annual cases occurred between January and May for pine processionary larvae, and April and August for oak processionary larvae (with a peak in March or June, respectively). Among the 1022 cases for which information was available, the sex ratio was 1.2 and the median age was 11 years old. Skin symptoms were reported by 96,3% of the cases, such as pruritus or urticaria. The severity was mild in 96.3% of cases, moderate in 3.5%, and severe in 0.2% (two cases). Ocular or oral exposures led more frequently to severe symptoms than dermal ones (respectively 31% and 18% vs. 2% of cases,Since processionary moth larvae exposure is a growing health concern, which can cause severe injuries particularly after ocular or oral exposures, the population, and the professionals should be informed of existing recommendations to avoid exposure and measures to be taken after being exposed.

International audience; Introduction: Ciguatera fish poisoning (CFP) is a common Poisoning in the tropical countries. France is directly concerned with French tourists in endemic area and with French citizens living in the French overseas territories. Method: Retrospective, descriptive study of CFP cases handled by the French Poison Control Centre Network from 2012 through 2019. Results: Fifty-two events were studied concerning 130 patients. The fish species was identified for 41 events, mainly belonging to five fish families: 14 groupers, 11 snappers, 5 jacks, 4 parrotfishes, 4 barracudas. The origin of the fish was the Atlantic Ocean (23 events), the Indian Ocean (17 events) and the Pacific Ocean (12 events). 91% of the poisonings occurring in the Atlantic Ocean began with gastrointestinal effects while in 44% of events occurring in the Pacific Ocean, the patients had no gastrointestinal effects (onset with neurological symptoms: paraesthesia and dysesthesia). The evolution of the 130 patients has been classic for CFP with persistent symptoms during 1 to 45 weeks. Numerous patients reported exacerbation of neurological signs several months after poisoning following consumption of alcoholic beverages (23 patients) or seafood (19 patients). Discussion: Medical practitioners in Europe must be trained to manage CFP as cases are reported with tourists returning from endemic areas but also with poisoned patients far from tropical areas after consumption of imported fish.

International audience; Importance: Since the accidental introduction of the yellow-legged hornet (Vespa velutina nigrithorax) in France in 2004, there have been reports of this insect unexpectedly projecting a liquid toward the human face, but ocular morbidity associated with this is unknown, to our knowledge.Objective: To describe a case series of ocular lesions after exposure to a liquid projection emitted by a hornet.Design, setting, and participants: This was an analysis of all cases of ocular exposure to a projection by a yellow-legged hornet (excluding stings in the eye) collected by French poison control centers between January 1, 2004, and December 31, 2019.Main outcomes and measures: Symptoms were evaluated, and a fluorescein eye stain test was used.Results: Twenty-nine cases were recorded (24 in male and 5 in female patients; median age, 40 [interquartile range, 11] years); the first occurred in 2009. Most cases (20 [80%]) were occupational exposure among professionals dealing with hornet nests (eg, firefighters, wasp exterminators). Symptoms consistent with conjunctivitis often resolved quickly after ocular decontamination, but 5 patients developed a periorbital edema, 2 experienced radiating neuropathic pain, and 2 experienced keratitis.Conclusions and relevance: These findings suggest that the projection of a liquid into the eyes by the yellow-legged hornet presents a new risk to human health, but its precise nature remains to be determined. Ocular lesions had a favorable outcome. For professionals who deal with these insects, adaptation of the usual protections designed for native hymenopterans may be warranted.

Context: During the re-approval process of glyphosate in Europe, it was mentioned that glyphosate-based products (GBF) were more toxic than glyphosate alone. This phenomenon was attributed ...

International audience; France is experiencing an increase in the number of opioid prescriptions and related fatalities. We carried out a retrospective observational study using data from the Paris PCC over a 10-year period. The main objective was to obtain an epidemiological description of the severe reported cases. The secondary objectives were to assess the evolution of the number of these cases and their severity defined by the use of fentanyl and its derivatives, the use of the opioid-poisoning treatment naloxone, and the number of fatalities. During 2008–2017, 268 511 cases were recorded, including 1 122 cases of opioid-related poisoning that required medical management. These poisonings involved tramadol (43%), codeine (25%), dextropropoxyphene (13%), and morphine (8%); most resulted from self-exposure (60%). During the 10-year study period, 130 opioid-related fatalities were recorded in the Paris area, mainly resulting from suicides (39%) in men and were attributed to morphine (27%), tramadol (24%), and methadone (21%). We did not identify an increase in the number of severe opioid-related poisonings or fatalities or in the use of fentanyl or its derivatives. Conversely, we observed an increase in the use of naloxone, suggesting an increase in the severity of opioid poisonings. Our findings show that, until 2017, the opioid overdose epidemiology in the Paris area is different to that in the USA. The systematic analysis of data from the PCCs could be a good tool for health monitoring. To assess trends in France, a national study over a longer period would also be useful.

Background Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. Methods A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

In France, pregabalin is widely prescribed in adults but still not approved for children. We aimed to investigate the incidence of pregabalin exposure in ≤6-year-old children, to describe the characteristics and outcome of ingestions involving pregabalin alone, and to estimate a clinically relevant toxic dose in this population. Retrospective analysis of pregabalin exposures in ≤6-year-old children, collected by the French Poison Control Centers in 2004–2019. The incidence was estimated using pregabalin prescription data from the Health Improvement Network database (the French version of THIN). The poison severity score (PSS) was used to grade severity. We found 313 unintentional immediate-release pregabalin ingestions in ≤6-year-old children. The number of cases per 100,000 pregabalin-treated adults increased over time (p p p Despite increasing prescriptions in adults in France, unintentional pregabalin ingestions in ≤6-year-old children remain rare and cause minimal toxicity. Children with no underlying neurological/cardiac disease and concomitant medication ingesting

Tinospora crispa is a popular traditional herbal plant commonly used throughout the world for treatment of various diseases, in particular type 2 diabetes mellitus. We report here a new case of toxic hepatitis in a 57-year old male patient in the French West Indies following the consumption of two aqueous extracts of fresh Tinospora crispa stems. It thus differs from two previously reported cases that concerned the chronic intake of powdered dry stems delivered in solid oral dosage forms (i.e. pellets and tablets). Liquid Chromatography-Diode Array Detection-Mass Spectrometry (LC/DAD/MS) analyses were performed on an aqueous extract of the offending sample that mimics the swallowed preparation. They revealed the presence of species-specific molecular marker borapetoside C (1) and thus enabled an unambiguous phytochemical identification. The exploration of tandem MS/MS data obtained by ultra-high performance liquid chromatography/electrospray ionization quadrupole time-of-flight mass spectrometry (UHPLC-ESI-QTOF-HRMS) allowed the identification of 17 additional cis-clerodane-type furanoditerpenoid lactones, analogues of 1. These results support the hypothesis that the mechanisms underlying hepatotoxicity of Tinospora crispa are the same as those encountered with furanoditerpenoids-containing plants such as Teucrium chamaedrys or Dioscorea bulbifera. In the context of type 2 diabetes treatment, we recommend that Tinospora crispa intake should be more closely monitored for signs of hepatotoxicity.

Eutectic mixtures of lidocaine and prilocaine are used during painful dermatological procedures. Poisoning is rarely reported in adults. We report three cases of women who experienced lidocaine and prilocaine poisoning after laser-assisted hair removal. Plasma levels of local anesthetics were assayed by a fully validated liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method. The rules of application of the anesthetic cream were observed apart from the maximum dose and/or maximum surface area. One patient applied a higher dose than the maximum recommended dose (140 instead of 60 g) and all patients failed to comply with the maximum recommended surface area (600 cm2). The patients presented an unusual clinical pattern as compared with other local anesthetics overdose: signs of cardiac toxicity with no ECG changes or arrhythmia, neurological toxicity without seizures or coma, and methemoglobinemia. Health authorities should publish explicit recommendations targeting users and prescribers with particular emphasis on the maximal surface area of application.

Resume Contexte et but de l’etude La plombemie est predictive des risques pour la sante du plomb et c’est sur elle que sont fondes le depistage et la prise en charge medico-sociale du saturnisme infantile. Cependant, le plomb sanguin etant essentiellement erythrocytaire, en cas d’anemie, la plombemie exprimee en μg/L sous-estime la dose interne de plomb, ce qui peut etre a l’origine d’une prise en charge inadaptee. Cette etude se propose d’evaluer l’impact de l’ajustement de la plombemie sur la concentration sanguine d’hemoglobine sur la prise en charge des enfants. Methodes C’est une analyse retrospective des cas du systeme de surveillance du saturnisme infantile en Ile-de-France (SSSIILF), concernant des enfants de 6 mois a 6 ans, pour lesquels on dispose de mesures simultanees de la plombemie et de la concentration d’hemoglobine, qui etaient porteurs d’une anemie et dont la plombemie etait insuffisante pour etre a l’origine de cette affection ( Resultats et discussion Globalement, l’existence d’une anemie a entraine une sous-estimation de la dose interne de plomb et une prise en charge medico-sociale inadaptee dans 3098 cas (10,73 %). Chez les enfants anemiques, la chute de l’hemoglobine, quelle qu’en soit la cause, doit imperativement etre prise en compte pour l’interpretation de la plombemie.

Objectif Confortee par un engouement recent, la Federation Francaise de Tir compte aujourd’hui plus de 200 000 licencies, qui frequentent plus de 1600 clubs. Si les risques lies a l’exposition au plomb engendree par la pratique du tir sont bien decrits dans la litterature medicale internationale [1] , ils paraissent insuffisamment pris en compte en France. L’objectif de ce travail etait de recenser les cas de contamination par le plomb liee au tir, portes a la connaissance du Centre antipoison de Paris. Methodes Interrogation de la base de donnees du Centre antipoison de Paris (periode 2010-2019) et de sa consultation de pathologie professionnelle et de l’environnement (RNV3P, periode 2001-2019). Inclusion de tous les cas d’elevation de la plombemie en lien avec le tir (plombemie au-moins egale a 25 μg/l chez l’enfant et 100 μg/l chez l’adulte), a l’exclusion des cas de plombs intracorporels. Resultats Parmi les 85 cas recenses, 54 ont ete recus en consultation, les autres ayant fait l’objet d’un conseil a distance. Neuf mineurs (le plus jeune etait âge de 10 ans) avaient des plombemies (en μg/l) reparties de la maniere suivante : [25–50] n = 2, [50–100] n = 1, [100–200] n = 3, [200 et +]n = 3 (maximum 393). Les resultats concernant les adultes sont indiques dans le Tableau 1 . Dans un tiers des cas, l’exposition au plomb sur un stand de tir etait–exclusivement ou non–professionnelle (employes du stand, n = 10 ; agents de nettoyage, n = 7 ; metiers de la securite, n = 5 ; autres, n = 3). Discussion L’experience du Centre antipoison de Paris a mis en evidence des contaminations importantes par le plomb en rapport avec la pratique du tir, touchant a la fois les tireurs sportifs (meme mineurs) et des travailleurs, qu’ils soient tireurs ou non comme les agents de nettoyage. Conclusion Il est indispensable de sensibiliser au risque plomb dans les stands de tir sportifs, de mettre en œuvre des mesures collectives de reduction des expositions et d’instaurer une surveillance medicale adaptee, qu’il s’agisse d’exposition professionnelle ou de loisir, notamment chez les enfants.

Introduction Les billes de polymeres super-absorbants (PSA) ont la capacite d’absorber l’eau jusqu’a plusieurs centaines de fois leur poids sec. Developpees en milieu agricole avant de trouver d’autres applications, leur commercialisation sous forme d’elements decoratifs ou de jeux est recente. En raison de leur caractere attractif, le risque d’ingestion par les enfants est eleve. Notre objectif etait de decrire l’evolution du nombre de cas d’ingestion de billes de PSA en France et leur evolution clinique. Methodes Etude observationnelle retrospective sur une periode de 10 ans (du 1er janvier 2010 au 31 decembre 2019) portant sur tous les cas d’exposition par ingestion de billes de PSA collectes par les centres antipoison en France. Resultats Pendant la periode d’etude, les centres antipoison francais avaient collectes 1 924 143 cas toutes causes confondues, dont 968 735 (50,3 %) concernaient des enfants (âge Discussion Hormis ce cas de deces, les resultats de notre etude etaient comparables aux rares series publiees a l’international par les centres antipoison. L’ingestion d’une bille de PSA ne se complique que parfois de troubles digestifs benins et rapidement resolutifs [1] . Pourtant, certaines billes vendues comme jouets ont ete retirees du marche aux USA et en Australie suite a la survenue de cas d’occlusion intestinale aigue apres ingestion. Dans la litterature, nous avons retrouve 27 cas publies d’occlusion intestinale aigue ayant necessite une extraction endoscopique ou chirurgicale, dont 1 cas de deces. Il s’agissait toujours d’enfants en bas âge (âge median: 15 mois (6-22 mois)). L’analyse de ces cas souligne la difficulte diagnostique en raison du caractere radiotransparent de ces corps etrangers. L’interet d’examens d’imagerie tels que l’echographie et la tomodensitometrie abdominales et la prise en charge chirurgicale sont precises [2] . Conclusion Au cours des 10 dernieres annees, on observait une augmentation exponentielle du nombre de cas rapportes d’ingestion de billes de PSA en population pediatrique en France. Les complications etaient rares mais de gravite elevee. Apres revue de la litterature, nous expliquons comment predire le risque d’occlusion selon la taille de la bille et proposons une strategie de prise en charge en pratique clinique.

Summary Diphenidine is a new psychoactive substance described by users as an anesthetic drug with mild stimulant potential and a large amnestic component. It appears to have been available since 2013, and was first detected in powders seized in 2014. Hair analysis allows distinction between acute or chronic drug consumption. Few data are available on diphenidine concentration in hair. We developed an analytical method in order to identify this compound in hair. After decontamination, 20 mg were grinded and incubated in phosphate buffer pH 5.0 in the presence of 100 ng of MDMA-d5 used as IS. Double basic liquid–liquid extraction was performed. Samples were separated on a 1.9 μm Hypersil GOLD PFP column (100 × 2.1 mm) using gradient elution. Compounds were detected by a LCQ TSQ Vantage XP triple-quadrupole mass spectrometer. The assay was accurate and precise over the range 10 pg/mg (lower limit of quantification) to 1000 pg/mg. A reproducible matrix effect around 40% was observed. We applied this method to a patient with a history of chronic drug abuse, who used diphenidine for the first time. He experienced dissociative effects, confusion, hallucinations, amnesia and severe temporal disorientation. A hair sample was obtained 49 days after ingestion, and was divided in five 1 cm-segments. Diphenidine was identified on the first three proximal segments, probably due to sliding hair in the strand, at concentrations of 123, 79 and 89 pg/mg. Twenty-three others compounds were also identified in hair, showing the multidrug abuser status of this patient.

Objectif Aujourd’hui, l’immunotherapie par fragments Fab ou F (ab ‘) 2 est consideree comme le traitement de reference pour les envenimations viperines [1] , [2] . Nous avons compare l’efficacite de deux antivenins, Viperfav®(VF®) et Viperatab® (VT®), en France metropolitaine en 2017-2018 a partir des donnees du reseau des centres antipoison francais. Methode Les patients presentant une envenimation moderee (grade 2a et 2b) ou severe (grade 3) apres morsure de vipere et traites par antivenin ont ete inclus. Les criteres de jugement choisis etaient le risque d’exacerbation de l’envenimation apres antivenin, la duree de sejour a l’hopital et la presence d’une gene fonctionnelle persistante a J15. Les etudes statistiques etaient basees sur l’analyse de donnees multivariees. Resultats 297 cas ont ete inclus. 182 (61,3 %) patients ont recu VF® et 115 (38,7 %) ont recu VT®. Comparee a VF®, l’utilisation de VT® a significativement augmente le risque d’exacerbation de l’envenimation apres antivenin (VF 1 % vs VT 11 % ; OR= 12,1 ; IC 95 % [3,1 ; 46,7] ; p 48 h) et la gene fonctionnelle persistante a J15. VF® et VT® ont une securite d’emploi similaire (p > 0,21). Par ailleurs, la duree d’hospitalisation a ete significativement augmentee lorsque l’antivenin etait administre au-dela de 12 heures (OR= 2,70 ; IC 95 % [1,45–5,06] ; p = 0,002) ou lors d’une administration preventive d’HBPM, (OR= 6,6 ; IC 95 % [1,6–27,1] ; p = 0,02). Par ailleurs, les patients recevant la perfusion d’immunotherapie du grade 2b presentaient des symptomes exacerbes significativement plus frequents (OR* 4,0 ; IC 95 % [1,2–13,7] ; p = 0,028) apres l’administration d’antivenin par rapport au groupe de grade 2a. Discussion Bien que VF® et VT® aient tous deux une tres bonne securite d’emploi, cette etude montre que VT® etait associe a un risque plus eleve d’exacerbation de l’envenimation apres antivenin par rapport a VF®. En outre, cette etude confirme que l’antivenin doit etre administre le plus precocement possible et confirme la contre-indication des HBPM en preventif. Conclusions Alors qu’aucune difference significative entre ces antivenins n’a ete enregistree en ce qui concerne la duree du sejour a l’hopital et la gene fonctionnelle persistante a J15, l’utilisation de VT®, par rapport a VF®, a augmente de maniere significative le risque d’exacerbation de l’envenimation apres antivenin (OR* 12,1 ; IC 95 % [3,1 ; 46,7] ; p

Objectives Acute carbon monoxide poisoning is common and often severe. Domestic causes have been extensively documented, while occupational exposures have been reported less frequently. We analyse occupational carbon monoxide poisonings from the available data of the carbon monoxide poisoning surveillance network for Paris and its region, and identify predictive factors of severity for occupational poisoning in order to identify priority prevention actions. Methods We retrospectively reviewed all events of acute accidental carbon monoxide exposures which occurred in the Paris region, at the work place, and notified to the surveillance network from 1 January 2005 to 31 December 2011. Results Over the 7-year study period, 362 exposed workers were identified, representing 8.15% of all cases of carbon monoxide exposures. The largest number of events occurred in the building sector and most commonly affected occupations were craft and related trades workers. The most common sources of exposure were internal combustion engine equipment that was involved in almost half of cases. Minor severity was observed in 86% of cases, and 13% were moderate or more. We identify that the use of internal combustion engine equipment was significantly associated with increased severity. Conclusions Occupational carbon monoxide poisoning is reported less frequently than domestic poisoning and has different and more numerous causes. It can be potentially severe, especially when it is caused by internal combustion engine equipment. Information about risks, compliance with instructions and cleaning rules, and establishment of collective and individual protective equipment would significantly reduce the frequency and severity of carbon monoxide poisoning.

Objectif Les cremes anesthesiantes a usage cutane issues de melanges eutectiques de lidocaine et de prilocaine a 5 % sont indiquees en cas de procedure dermatologique douloureuse telle que l’epilation au laser. Bien connus chez les enfants [1] , les cas d’intoxication par ces cremes chez les adultes sont rarement decrits. Description des cas Nous rapportons les cas de 3 femmes ayant presente en 2017 un surdosage en lidocaine et prilocaine avant epilation au laser. Le centre antipoison avait participe a la gestion des cas et les donnees avaient ete saisies dans le systeme d’information. Les dosages plasmatiques des anesthesiques avaient ete realises par chromatographie liquide couplee a un spectrometre de masse en tandem (HPLC-MS/MS). La 1re patiente avait applique 55 g d’Anesderm® sur une surface estimee a 2068 cm2 et avait presente une methemoglobinemie mesuree a 13,9 % (H8). L’evolution etait favorable apres traitement antidotique par bleu de methylene. Les concentrations plasmatiques de lidocaine, de son metabolite (MEGX) et de la prilocaine etaient respectivement de 2500, 766 et 707 ng/mL (H8). La deuxieme patiente avait applique 50 g d’Emla® sur une surface estimee a 2068 cm2 et avait presente des palpitations suivies d’un malaise sans perte de connaissance avec une SaO2 a 92 % (H2). La methemoglobinemie n’etait pas recherchee. L’evolution etait favorable apres prise en charge symptomatique. Les concentrations plasmatiques de lidocaine et prilocaine etaient respectivement de 1028 et 992 ng/mL (H4,8). La troisieme patiente avait applique 140 g d’Emla® sur une surface estimee a 4510 cm2 et avait presente des palpitations, des vertiges et une methemoglobinemie mesuree a 17,4 % (H7). L’evolution etait favorable apres prise en charge symptomatique. Les concentrations plasmatiques de lidocaine, de MEGX et de prilocaine etaient respectivement de 2210, 562 et 760 ng/mL (H9,3) ; puis de 1880, 524 et 690 ng/mL (H11) ; puis de 766, 294 et 193 ng/mL (H17,5). Resultats Les modalites d’application de la creme (dose et/ou surface d’application) n’etaient pas conformes au resume des caracteristiques du produit (RCP). Une patiente avait applique une dose superieure a la dose maximale recommandee (60 g) et les 3 patientes n’avaient pas respecte la surface maximale d’application recommandee (600 cm2). Ces cremes anesthesiques contiennent a la fois de la lidocaine et de la prilocaine. Les patientes n’avaient pas presente d’effets neurologiques ou cardiovasculaires habituellement rapportes lors de surdosages en lidocaine administree par voie injectable. En revanche, elles avaient presente une methemoglobinemie attribuable a la prilocaine et probablement aussi a la lidocaine. Conclusion Les effets observes pouvaient etre expliques par le depassement de la surface d’application maximale recommandee dans le RCP. Il conviendrait d’emettre des recommandations plus explicites sur la surface d’application a ne pas depasser en ciblant les utilisateurs et les prescripteurs.