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Objectives To determine the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000-2018. Design, setting Analysis of national data on barbiturate-related hospitalisations (National Hospital Morbidity Database, 1999-2000 to 2017-18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002-03 to 2017-18), and deaths (National Coronial Information System, 2000-01 to 2016-17). Main outcome measures Population rates directly age-standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression. Results We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate-related hospitalisation rate declined from 0.56 in 1999-2000 to 0.14 per 100 000 population in 2017-18 (AAPC, -6.0%; 95% CI, -7.2% to -4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, -5.8%; 95% CI, -9.1% to -2.4%) and intentional self-harm (AAPC, -5.6%; 95% CI, -6.9% to -4.2%) were each statistically significant. Despite a drop from 0.67 in 2002-03 to 0.23 per 100 000 in 2003-04, the drug treatment episode rate did not decline significantly (AAPC, -6.7%; 95% CI, -16% to +4.0%). The population rate of barbiturate-related deaths increased from 0.07 in 2000-01 to 0.19 per 100 000 population in 2016-17 (AAPC, +9.3%; 95% CI, +6.2-12%); the rate of intentional self-harm deaths increased (AAPC, +11%; 95% CI, +7.4-15%), but not that of accidental deaths (AAPC, -0.3%; 95% CI, -4.1% to +3.8%). Conclusions While prescribing and community use of barbiturates has declined, the population rate of intentional self-harm using barbiturates has increased. The major harm associated with these drugs is now suicide.

Aluminum phosphide (ALP) is a pesticide agent and infrequent culprit of accidental poisoning. We present a case of severe reversible cardiomyopathy and left ventricular apical thrombus in a patient who worked as an exterminator and had ALP poisoning.

In the elderly, a significant decline in the liver and renal function was observed with increasing aging. This study aims to identify the characteristics of elderly with acute poisoning and analyzed the difference between Asia and non-Asia. We gathered works of literature from the Google Scholar database and PubMed with limits in human, English, MEDLINE, age above 65 years old, and title or abstract of “acute poisoning in the elderly” from the year 1983 to 2019. During the 36 years, 11 articles from Google Scholar (including 9 articles in PubMed) with 34,593 patients were included to study. Data of age, gender, etiology, poisoned substance, outcome, length of stay (LOS), and mortality rate were collected, and we divide them into two groups: Asia and non-Asia, to compare the diversities and discussion were made. The mean ± SD (standard deviation) in age is 72.3 ± 4.5 years old. Of these patients, 57.8% were male. Accidental poisoning was more common in elderlies. Of the types of poisoning, drugs were the most common substance (40.4%). Among all the cases in this study, 60.2% were admitted to the hospital after poisoning. Of them, 26.2% were admitted to an intensive care unit (ICU). The mortality rate of the study participants was 13.2%. Most of the poisoned elderly patients are unintentional, and drug (BZDs) is the most common agent poisoned. Asia group of poisoned elderly patients are older, male predominant, more intentional, and having a higher rate of mortality than the non-Asia group.

A female patient presented with typical angina, as well as dizziness, trembling, and repeated vomiting, after accidental poisoning with sodium selenite. Our case illustrates the role of selenite in myocardial function and provides guidance for cardiovascular management of rare cases of selenite poisoning. (Level of Difficulty: Beginner.), Central Illustration

Accidental poisoning in children, though underreported in our environment, is common and could prove fatal. It is important to identify the primary chemical agent that is responsible for the poisoning. We present a case of accidental ingestion of fish poisoned with aluminum phosphide (AlP) used as rat poisoning by a 14-month-old girl. At presentation, the actual chemical content of the poison was not available and clinical features were suggestive of organophosphate poisoning. She was commenced on atropine together with other treatment, on which she made remarkable improvement. The atropine was continued with complete resolution of symptoms on the third day of admission. We, therefore, report a serendipitous use of atropine in the management of AlP poisoning with successful outcome.

Medication errors occur as a result of failure in the treatment process at any point in the healthcare system. This is a retrospective study aimed at determining the rates of medication-related errors over a 10-year period in hospitals in Victoria, Australia. From 2009 to 2019, the overall rate for adverse drug events, accidental poisoning and undetermined intent were 86.15, 1.3 and 0.17 per 10,000 hospital separations, respectively. Medication complications occurred more in public hospitals. Adverse drug events account for less than 1% of all hospital separations. Medication errors contributing factors should be investigated in out of hospital environment.

Objective: This study aimed to adequately investigate the most frequent causes of poisoning in camels and sheep in the Kingdom of Saudi Arabia (KSA). Methods: Appropriate data were carefully collected from the recorded animal poisoning cases in the Veterinary Health and Monitoring Department, Ministry of Environment, Water and Agriculture (MEWA), during the period (from 2018 to 2019). All recorded cases were accurately diagnosed with a case history and reported clinical signs as well as definitive confirmation by laboratory analysis of the collected samples. Results: From the recorded data of 852 camel and sheep poisoned cases, the results showed that the primary causes of animal poisoning in Saudi Arabia were Cyanogenic glycosides (42.25%), Pesticides (26.76%), Mycotoxins (18.8%), and Drugs (12.2%). These cases were recorded only in 5 geographical regions (Riyadh, Qassim, Makkah, Northern borders, and Eastern province) Conclusion: Accidental toxicity in camel and sheep in KSA was mainly caused by Cyanogenic glycosides, Pesticides, Mycotoxins, and Drug toxicity. The frequent reasons for possible toxicity should be minimized through active veterinary extension.

Introduction: Poisoning in children is an important Paediatric emergency and is a worldwide problem. It is a common and preventable cause of morbidity and mortality in children. Objectives: The aim of this study was to determine the profile and outcome of children less than 13 years admitted to the Paediatric department presenting with acute poisoning at a Teaching district hospital in southern Karnataka. Methods: Prospectively, 134 acute poisoning cases, admitted to Paediatric intensive care, SIMS Shivamogga from November 2018 to May 2019 were included in this study. Results: During the study period, 134 patients presented with acute poisoning. The incidence of poisoning in Paediatric patients was 2.84%. The median age of our patients was 5.2 years (range 0.75-12 years). The male to female ratio was 1.58:1. Animal bites (27.61%), Petroleum products (26.87%), Household chemicals (15.67%), Drugs (11.19%), Poisonous plant derivatives (8.96%) and Insecticides (6.72%) were the agents most frequently implicated. Almost all (98.41%) cases in 1 to 5 years age group were accidental in nature, whereas in the >10 years age group, the majority (71.43%) were suicidal. Thirteen patients (9.7%) remained asymptomatic. The specific antidote was given to 19 (14.18%) patients. Three patients (2 snake bite and 1 rodenticide child) died. The mean duration of hospital stay was 4.49 days (range was 1 day to 22 days). Conclusions: Accidental poisoning was common in children below 5 years of age. Minimal age of suicidal poisoning was 8 years. The most common agent implicated was a snake bite.

ObjectiveAims were (1) to assess the characteristics, associated factors and compliance of patients with acute poisoning advised by the Belgian Poison Centre (BPC) to go (conditionally) to the hospital, (2) to assess the compliance and potential health-economic impact.MethodsThree types of referrals to the hospital of patients who called the BPC between 1 January and 30 June 2018 were analysed: referrals in case of deterioration in the patient’s condition (Hosp-watchful-wait), referrals (Hosp-referral) or urgent referrals (Hosp-urgent-referral). Factors associated with type of recommendation were registered. A survey was conducted on a second dataset of patients who called the BPC between 1 March and 15 May 2019 and referred (conditionally) to the hospital.Results5476 referrals were included: 72.4% accidental poisoning, 25.3% intentional self-harm, 1.2% substance abuse and 1.1% unclear intentionality. There were 2368 (43.2%) Hosp-watchful-wait cases, 2677 (48.9%) Hosp-referrals and 431 (7.9%) Hosp-urgent-referrals. In Hosp-watchful-wait cases, soaps and detergents were represented most (20.5%). In Hosp-referrals and Hosp-urgent-referrals, benzodiazepines (12.7% and 15.1%, respectively) predominated. Factors associated with hospitalisation type were number of symptoms, intentionality, type of agent(s) involved and advising antidotes. The survey showed that 7.8% of Hosp-watchful-wait patients went to the hospital versus 57.3% of Hosp-referrals and 59.6% of Hosp-urgent-referrals. The mean cost for Hosp-watchful-wait patients, Hosp-referrals and Hosp-urgent-referrals was estimated at €127, €767 and €796, respectively.ConclusionOnly a small proportion of patients followed the advice of the BPC to go (conditionally) to the hospital. A systematic follow-up of cases is warranted to examine the appropriateness of referrals and the compliance of patients.

The suicide rates officially reported by most countries are widely believed to be lower than actual rates, attributable partly to inaccuracy of registration of deaths and misclassification of cause of death. In this review paper, we discuss under-counting of deaths and of suicides, referring to findings from international research. We then describe the three main ICD-10 cause of death categories that possibly harbour 'hidden suicides': ill-defined or unknown causes of death, events of undetermined intent (EUI), and accidental deaths. We used the 2017 Australian mortality statistics to illustrate these three categories. The World Health Organization (WHO) data and international research show (1) that mortality data provided to the WHO by a large number of its Member States are of questionable quality and not timely; and (2) substantial variations among countries in rates of suicide, ill-defined or unknown deaths, EUIs, and accidental deaths (notably, poisoning). Accurate reporting of suicides is needed to advance research on suicide prevention and develop more effective suicide prevention programmes. Nations should endeavor to obtain, publish and analyse data regarding annual rates of deaths coded as of ill-defined/unknown cause, EUI, and accidental poisoning and other relevant types of accident.

Introduction:The aim of this study is to analyze the interventions of acute intoxications in pediatric intensive care unit (PICU) admissions and to determine the aspect of critical care support by using the demographic and clinical outcomes.Methods:593 PICU admissions due to intoxications between 2013 and 2018 were enrolled in the study. Demographics, drugs/substances received, voluntary or accidental drug intake, time of elapse from drug intake to PICU admission, length of PICU stay and hospitalization, adverse effects (clinically significant and non-clinically significant effects), PICU interventions, PRISM-3 score and clinical findings were extracted from the files.Results:Accidental poisonings mainly occurred in 2-5-year-old children, in males (51.2%) at summer season. Antipiretics/analgesics, cardiac medications and insecticides were the most frequent substances. Children with voluntary poisonings had increased multi-drug intake, higher PRİSM-3 scores, longer PICU stay and hospitalization (p

Acil servisine başvuran çocuk ve yetişkin zehirlenme olgularının retrospektif olarak değerlendirilmesi ile zehirlenmelerin önlenmesi adına yapılması gerekenlerin tekrar gözden geçirilmesi, zehirlenme olgularına yaklaşımda yeni gelişmelerin ışığında tedavi ilkelerinin geliştirilmesi ve gelecek uygulamalara katkıda bulunabilmek hedeflenmiştir.İstanbul Eğitim Araştırma Hastanesi Acil Tıp Kliniğine 2010-2018 yılları arasında zehirlenme sonucu ile başvuran çocuk ve yetişkin olguların verileri klinik ve retrospektif olarak incelenmiştir. Çalışma verileri SPSS ver15.0 programıyla değerlendirilmiştir.Çalışmamızda toplam 654 hasta ile analiz gerçekleştirildi. Olguların 337’si kadın, 317’si erkek olarak belirlenmiştir. Yaş ortalaması kadınlarda 36.16 erkeklerde ise 36,72 olarak bulunmuştur. Kaza ile zehirlenmeler % 85,2’lik oranıyla intihar amaçlı zehirlenmelere (% 9,5) göre daha sık görülmüştür. Yaş gruplarına göre zehirlenme etkenleri değerlendirildiğinde %24.2 oranıyla en sık zehirlenme nedeni olarak kaza ile zehirlenme belirlenirken, 50 yaş üstünde kaza ile zehirlenme oranının en yüksek olarak gözlemlendiği yaş grubu olarak belirlendi. İntihar amaçlı zehirlenme oranın en yüksek olarak görüldüğü yaş aralığının 20-29 olduğu belirlendi. Zehirlenme vakalarının en sık gözlemlendiği ayların Kasım (9,8%), Aralık (10,9%), Ocak (13,5%) ve Şubat (15,7%) olduğu gösterilmiştir. Çalışmamız İstanbul ilindeki zehirlenmelerin demografik özelliklerini yansıtmaktadır ve ülkemizde gerek çocukluk çağı zehirlenmelerine gerek yetişkinlerin zehirlenmelerine karşı alınacak önlemlere katkı sağlayacağı düşünülmektedir. Zehirlenme olgularının önüne geçilebilmesi, tedavi protokollerinin geliştirilmesi, araştırma hedeflerinin daha iyi anlaşılabilmesi ve zehirlenmeler hakkında güncel bilgilere erişimin yaygınlaştırılabilmesi için epidemiyolojik çalışmalara oldukça ihtiyaç vardır.

Background Poisoning has become a widespread and dangerous phenomenon worldwide. The purpose of our study was to determine and analyze the pattern of poisoning cases induced with food, drugs, and chemicals reported to the Department of Environmental and Occupational Health in Qassim province in the Kingdom of Saudi Arabia. The study also evaluated the correlation of demographic variables such as age, type of toxicity and geographical distribution associated with poisoning in Qassim province. Methods This retrospective cross-sectional study was performed on 381 cases of poisoning. The data was collected from Jan 2017 to Dec 2017 and revealed that out of 381 cases, 120 have food poisoning (65 % females and 35 % males), 180 have drug poisoning (55.56 % females and 44.44 % males), whereas 81 cases have chemical poisoning (41.98 % female and 58.02 % male). Data were statistically analyzed using SPSS/PC statistical package. The study revealed that the most common agents involved in acute poisoning were drugs (47.25 %), especially analgesics such as Paracetamol (Acetaminophen), followed by antipsychotic drugs. Food poisoning was the second acute poisoning with (31.40 %). Finally, chemical poisoning involved in acute poisoning with 21.20 % of cases reported household products accomplished strongest bleach (chlorines)(Clorox®) and insecticides were the secondary source for chemical poisoning.

Buprenorphine has pharmacologic advantages over methadone, especially buprenorphine's better safety profile. The true significance of buprenorphine's introduction lies in returning the care of those suffering from opioid use disorder (OUD) to the hands of the physician. The clinical success of buprenorphine has been meager, in part because most physicians have not been exposed to treating these patients. For physicians inclined to treat OUD, the barriers to buprenorphine's implementation have been onerous and largely counter to the norms of medical practice. Some notable concerns pertain to buprenorphine's clinical pharmacology like street diversion, unintended use and accidental poisoning. Recently, injectable buprenorphine preparations have been introduced to mitigate these latter shortcomings. Yet, the injectable preparations' clinical and commercial success has fallen far short of expectation. Here, we review the clinical pharmacology of these products and their expected clinical advantages for the manufacturers, clinicians, policy makers and patients, and offer our perspective, as clinicians and researchers, on how things can improve. Questions remain whether clinicians are willing to overcome barriers to treat OUD using these medications.

Background: Carbon monoxide (CO) poisoning is the leading cause of poisoning death worldwide, but associations between CO poisoning and weather remain unclear.Objective: To quantify the influence of climate parameters (e.g., temperature, relative humidity, and wind speed) on the incidence risk of acute CO poisoning in Taiwan.Methods: We used negative binomial mixed models (NBMMs) to evaluate the influence of weather parameters on the incidence risk of acute CO poisoning. Subgroup analyses were conducted, based on the seasonality and the intentionality of acute CO poisoning cases.Results: We identified a total of 622 patients (mean age: 32.9 years old; female: 51%) with acute CO poisoning in the study hospital. Carbon monoxide poisoning was associated with temperature (beta: −0.0973, rate ratio (RR): 0.9073, p < 0.0001) but not with relative humidity (beta: 0.1290, RR: 1.1377, p = 0.0513) or wind speed (beta: −0.4195, RR: 0.6574, p = 0.0806). In the subgroup analyses, temperature was associated with the incidence of intentional CO poisoning (beta: 0.1076, RR: 1.1136, p = 0.0333) in spring and unintentional CO poisoning (beta: −0.1865, RR: 0.8299, p = 0.0184) in winter.Conclusion: Changes in temperature affect the incidence risk for acute CO poisoning, but the impact varies with different seasons and intentionality in Taiwan. Our findings quantify the effects of climate factors and provide fundamental evidence for healthcare providers to develop preventative strategies to reduce acute CO poisoning events.

Background Globally, attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder that affects children. In 2011, there was an ADHD diagnosis prevalence of around 8% among children (4-17 years) in the US. ADHD-affected children are more prone to physical injuries such as physical trauma, accidental poisoning, burns, etc. This study was aimed to evaluate the association of ADHD with severe injuries, the influence of age and gender on this association, and the impact of ADHD medications on the frequency of such injuries. Methodology This study was conducted in three governmental and three private settings in Aseer region. The files of children who were diagnosed with ADHD in the study settings were reviewed for a 12-month time period. Data were extracted from the medical files using a pre-structured data extraction sheet to avoid errors and inter-rater bias. The extracted data included child gender, age, duration of disease, and injury-related data. A brief questionnaire had been applied to mothers regarding mothers' attitudes towards injuries among their children, adherence to medications, as well as the reasons for non-adherence to medications and clinical visits in a non-adherent group during the clinic visit. Results One hundred and sixty-three children with a diagnosis of ADHD completed the study. The affected children were aged between two and 15 years (mean: 7.8 ± 2.9 years). An exact of 116 (71.2%) children were males. An exact of 70 (42.9%) affected children had trauma. The most-reported traumas were superficial injuries (84.3%), burns (48.6%), fractures (37.1%), deep injuries (31.4%), and broken or lost teeth (28.6%). About 52% of the children were adherent to medications and their clinical visits. Among the non-adherent group, the most reported reasons were parents' care and attention (20.5%), followed by the COVID-19 pandemic and delay in visits times (16.7%). Regarding mothers' attitudes towards injuries among children with ADHD, 49.1% of the mothers agreed that there is an association between a child with ADHD and being traumatized while 22.7% said there was no relation. Conclusions In our cohort, the majority of the children with ADHD were boys at primary school age. Association of the history of the disease with trauma was not uncommon, and most injuries were not severe, but burns and deep injuries were reported among considered portions.

Accidental poisoning in children is very common, making up 10.9% of all unintentional injuries worldwide. Africa has the highest incidence of fatal poisonings worldwide, at 4 per 100,000. Poisoning with podophyllin is rare, with most cases documented around the 1970s to 1980s. Podophyllin is a resin mixture obtained from the dried Rhizome and roots of Podophyllin peltatum (North America) and Podopyllin emodi (India). Podophyllotoxin is the most toxic chemical present in the podophyllin, which is lipid soluble; so crosses the cell membrane easily and inhibits mitotic spindle formation. Both topical application and oral consumption can cause podophyllin poisoning. Neurotoxicity is the most serious effect along with bone marrow depression, gastrointestinal irritation, and hepatic and renal dysfunction. Management of podophyllin toxicity is mainly symptomatic, and no specific antidote exists. We report a case of a 2-year-old-year girl with accidental podophyllin poisoning, who presented with neurotoxicity followed by multiorgan dysfunction and then succumbed. Education of parents and healthcare workers on home safety still remains the mainstay of prevention. How to cite this article: Jain MK, Patnaik S, Rup AR, Gaurav A. A Rare Case of Podophyllin Poisoning: Early Intervention is Lifesaving. Indian J Crit Care Med 2020;24(6):477–479.

Aconitine intoxication by ingestion of Aconitum roots can lead to ventricular tachycardia and cardiac arrest and provides an example of the potential effect of self‐medication. Educational campaigns should be implemented to contain acute intoxications caused by herbal‐derived products.

Accidental poisoning is most common in children, but deliberate self-harm becomes predominant in teenagers and early adulthood. The epidemiology of poisoning can be studied using mortality data, hospital admission rates and enquiries to poisons information services. Effective strategies for preventing suicide and reducing the risk of accidental poisoning require an understanding of the epidemiology of poisoning.

Accidental poisoning in children is a common pediatric emergency. Here, we report the case of a 7-year-old girl with Amitraz poisoning. Ingestion and dermal contact with a dissolved solution of Amitraz lead to acute toxicity, which mimicked organophosphate poisoning. The patient lost consciousness which prompted their presentation to the pediatric emergency department. Limited literature is available regarding Amitraz poisoning. This case report attempts to document the findings and raise awareness to hasten identification and treatment of a rare and newer poison, Amitraz.

Introduction: Dichloromethane (DCM) and trichloroethylene (TCE) are both common halohydrocarbons which are widely used in industry. The most common exposure route of DCM or TCE is inhalation, but intramuscular injection of DCM and TCE is very rarely. Case presentation: A 47-year-old male presented ecchymosis, pain, and swelling of the left limb following accident injection of ABS glue (main ingredients were DCM and TCE). The swelling of his left limb was lasted until day 6 and WBC, NEUT, CK, CK-MB, LDH, AST and ALT were elevated until day 9. He was received intravenous fluids, analgesic, antibiotics, and other supportive measures and finally discharged from the hospital on day 16. Discussion: Both DCM and TCE could cause local irritation and systemic toxicity involving central nervous system, liver, kidney and other organs. In this case, because the small dose of toxicant and injection being the route of exposure, the patient mainly suffered from local toxicity resulting in painful soft tissue swelling with slight hemocytology and biochemistry disorder. Although there are no specific antidotes for DCM and TCE poisoning, supportive measures may also provide satisfactory therapeutic results. Conclusions: DCM and TCE poisoning following intramuscular injection could present mainly with local and system poisoning symptoms and successfully treated with supportive measures.

Objective: Acute poisoning is a common cause of hospital admission in Bangladesh. But, risk factors and characteristics of victims of different modes of poisoning have not been evaluated for possible intervention strategies. So, in this study we aimed to describe the pattern of acute poisoning in central Bangladesh as well as identifying risk factors for various mode of poisoning. Methods: A prospective observational study was undertaken in Dhaka Medical College Hospital in 2015. Consenting adult acute poisoning victims were included as study subjects. A pretested structured case record form was used to systematically record the cases. The poisoning cases were defined by clinical toxidrome (sympathomimetic, antimuscarinic, opioids, cholinergic, sedative, etc) during acute presentation with suspected poisoning and groups accordingly. SPSS 20 was used for data analysis and statistical tests including mean ± standard division (SD), percentage, t test and chi-square were used accordingly. Results: Total poisoning cases were 1155. Suicidal (62.25%, n=719), commuter poisoning (24.16%, n=279) and accidental poisoning (12.38%, n=143) were main types of poisoning. Risk factors of suicidal poisoning were young females of 11 to 30 years, married, housewives and students (P

No Abstract

Para phenylenediamine (PPD) is a common component of hair dye as well as temporary tattoos and is a well-known cause of type 4 hypersensitivity reactions from topical exposure. While there have been several cases reported in the literature describing toxicities following ingestion, there are a paucity of reports of severe systemic disease following topical exposure. Cases of PPD ingestion have been reported to present with angioedema-like reactions, often progressing to rhabdomyolysis and renal failure. To our knowledge, there have only been two reported cases of severe reactions following topical exposure to PPD. We present a case of a 59-year-old man with topical exposure to hair dye who presented with an angioedema-like reaction shortly after topical exposure to PPD containing hair dye that rapidly progressed to rhabdomyolysis, renal failure, and eventually death.

Datura is a common plant in India that grows abundantly in the wild across the country. The common names of datura plant are Jimson weed, Stinkweed, Devil’s trumpet, Mad apple and Thorn apple etc. It is considered as a deliriant poison. Very few cases of intentional poisoning with Datura are reported in the literature. But accidental poisonings are though rare but not uncommon.Hereby we present a case of 37 years old male, who got poisoned by datura accidentally, following which he developed giddiness and was brought to our hospital. The diagnosis and treatment of the datura poisoning will be discussed. Keywords: Dhatura, Deliriant, Accidental poisoning.

Background: Deaths due to poisons form inexorable part of all unnatural deaths in the current era of social,cultural and personal dilemma existing among mankind. Stress, poverty, financial insecurities, personal conflicts,unemployment, ill health, psychological disturbances, difficulties in psycho-social adaptability and lonelinesscontribute significantly to the ever-increasing mortality in poison deaths.Methods and results: A 20-month prospective descriptive study was conducted at the Department of ForensicMedicine and Toxicology, Victoria Hospital, Bangalore Medical College and Research Institute on cases ofdeath due to poisoning. Out of 110 cases, maximum number of cases were male (63.63%), in the age groupof 21-30 years (33.63%). 92.72% belonged to Hindu religion and 55.45% belonged to the upper lower class.54.54% belonged to urban areas and 60% were married victims. Maximum numbers of cases (38.18%)were recorded in winter, commonly between 5pm – 10 pm (39.09%) and 84.54% occurred at the placeof residence. 84.54% of cases were suicidal in nature with psychological causes being the most commonmotive (30.90%). 81.81% of cases received treatment and 34.53% succumbed to death within 1-7 daysof consumption of poison. Organophosphorus group of insecticide (50%) was the most common poisonencountered, followed by Phosphide ions (30%).Conclusion: Poisoning is a major epidemic of non-communicable disease in the present century. Suicidaland accidental poisoning are significant contributors to morbidity and mortality throughout the world.

AIM The aim of this study is to describe the epidemiology and health-care utilisation of paediatric emergency department (ED) presentations due to poisoning. METHODS A retrospective review of all ED presentations of paediatric poisoning cases (

Objectives To evaluate the sociodemographic and clinical characteristics of patients presented with acute self-poisoning at a tertiary care hospital in Pakistan. Methods and Patients A comparative study was conducted at Lady Reading Hospital MTI between May 2018 to May 2019 for a duration of 12 months. All patients diagnosed with acute self-poisoning were included in the study. Patients with inconclusive diagnosis, who were dead prior to the arrival to the hospital, or had an incomplete history of poison exposure were excluded from the study. At the time of arrival to the emergency department, the patient was first stabilized. Patients were grouped into two according to the type of exposure, i.e., accidental self-poisoning and deliberate self-poisoning (DSP). Sociodemographic and clinical characteristics of patients were recorded in a preformed proforma. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 26 (IBM Corp., Armonk, NY, USA). Results The mortality rate in patients with accidental poisoning was 9.62%, whereas it was 26.28% in DSP patients. Data were stratified according to the mode of poisoning, i.e., accidental vs DSP, and variables were assessed in patients who did not survive. It was found that 60% of patients who died in the accidental group were aged 0-15 years. In contrast, only one patient between aged 0-15 years died in the DSP group and the majority of the deaths occurred in those aged 25.1-35 years (31 [75.6%]). Conclusions In conclusion, women more often attempted suicide, whereas males suffered accidental poisoning more frequently. Firstly, we found a female predominance in the DSP group, whereas males were more prevalent in with young children experiencing accidental poisoning. Longer time from ingestion of poison to the arrival is associated with poor patient prognosis.

Aims Despite a global campaign on the dangers presented by liquid detergent capsules (LDC) – which look like sweets to a toddler - young children continue to present to emergency departments with LDC ingestion. We aimed to determine how often LDCs, or ‘liquitabs’, were the cause of children presenting with accidental poisoning to our two emergency departments. Methods We performed a retrospective analysis of all children less than 5 years old and presenting between July 2016 and July 2018 with an accidental poisoning to the emergency departments at the John Radcliffe Hospital, Oxford, and the Horton Hospital, Banbury. Children with either deliberate, food or unknown poisoning were excluded. As an audit, the study did not require ethical approval. Results Among 214 children with accidental poisoning (median age of 2 years, 52.3% male), LDCs were the commonest cause (27 cases, 12.6%), followed by paracetamol (15, 7%) and carbon monoxide (10, 4.7%). There were 103 different substances recorded, with personal care products forming the largest group (110, 51.4%) followed by medications (57, 26.6%). Most children were asymptomatic (173, 80.8%). The commonest symptom was vomiting (22, 10.3%). A quarter had an ECG performed (47, 22%) and 31 (14.5%) children had a blood test. All children were discharged from the emergency department after a period of observation. Conclusion LDCs were the commonest cause of accidental poisoning in young children presenting to our emergency departments. Healthcare workers should engage with industry to make packaging of LDCs safer to prevent continued presentations by young children with LDC poisoning.

Background: Accidental childhood poisoning is a recognized preventable cause of morbidity and mortality among children worldwide. This studywas aimed at determining the prevalence, pattern, and outcome of childhood poisoning among children in Abakaliki, Ebonyi State. Material and Methods: Medical records of all cases of accidental childhood poisoning admitted into Children’s emergency room (CHER) of the health facility of study between January 2014 and December 2018 were retrospectively identified and relevant data extracted and analyzed usingSPSS version 22. Results: Out of the 7,700 children that presented to CHER over a 5- year period, 42 were cases of poisoning, giving prevalence rate of 0.5%. Of the 42 cases, only 20 case notes were retrieved. The male to female ratio was 2.3:1 while the ages ranged between 6months and 14 years with the mean age of 3.06±2.88. Kerosene poisoning had the highest proportion of 50.0% (10/20) with the overall mortality rate of 5.0% (1/20).The relationship between age, place of residence and outcome in poisoned children was statistically significant (p = 0.038, 0.045 respectively). Conclusion: Accidental childhood poisoning is common in Abakaliki. Kerosene still remained the major agent while male toddlers were most vulnerable. There is need to intensify enlightenment campaigns and education of the public about the hazard of improper storage of kerosene and other implicated substances at home. Keywords: Accidental poisoning, Childhood, Kerosene

Background: The young child can be at risk of accidental poisoning because of its being very inquisitive to mouth objects. The prevalence and typesof poisoning vary within Nigeria and different parts of the world. Aim: To describe the sociodemographics, clinical features and outcome in childhood poisoning seen at the National hospital Abuja (NHA) Nigeria. Subjects and Methods: A descriptive prospective study on children admitted for acute poisoning from September 2014 -August 2016. Consecutive children with a history of poisoning were recruited during the study period. The children were examined, and poison severity scores were recorded into a proforma, and followed up till discharge or demise. Results: Twenty-two children were admitted for acute poisoning, out of the 2336 children seen during the study period, with a prevalence rate of 0.94%. Fourteen (63.6%) were of upper social class, with 12 (54. 5%) mothers having tertiary level education. The mean time (±SD) of presentation was 11.9 ± 23.9 hours, while the mean (SD) duration of hospital stay was 4.8 ± 6.2 days; hospital stay was significant with types of poisoning (Fisher exact test 22.062, p

Background and objectives Overall mortality among U.S. adults was stable in the past years, while racial disparity was found in 10 leading causes of death or age-specific mortality in Blacks or African Americans. However, the trends in sex- and race-adjusted age-standardized cause-specific mortality are poorly understood. Methods We here aimed at identifying the UCD with sex- and race-adjusted, age-standardized mortality that was changing in recent years. We extracted the data of underlying causes of death (UCD) from the Multiple Cause of Death database of the Centers for Disease Control and Prevention (CDC). Multivariable log-linear regression models were used to estimate trends in sex- and race-adjusted, age-standardized mortality of UCD during 2013-2017. Results A total of 31,029,133 deaths were identified. Among the list of 113 UCD compiled by the CDC, there were 29 UCD with upward trend, 33 UCD with downward trend and 56 UCD with no significant trend-changes. The 2 UCD with largest annual percent change were both nutrition related (annual percent change= 17.73, 95% CI [15.13-20.33] for malnutrition, and annual percent change= 17.49, 95% CI [14.94-20.04] for Nutritional deficiencies), followed by Accidental poisoning and exposure to noxious substances. Conclusions This study thus reported the UCD with changing mortality in recent years, which was sex- and race-adjusted and age-standardized. More efforts and resources should be focused on understanding, prevention and control of the mortality linked to these UCD. Continuous monitoring of mortality trends is recommended.

Publisher's version (útgefin grein), Objectives The aim was to study mortality due to suicide, accidental poisoning, event of undetermined intent and drug-related deaths through 20 years in Iceland. Design A population-based register study. Participants Individuals who died due to road traffic injury, suicide, accidental poisoning, event of undetermined intent and drug-related deaths in the population of Iceland during the years 1996-2015. Annual age-standardised rates were calculated, and the trend analysed by Pearson correlation and joinpoint regression. Setting The population of Iceland framed the study material, and the data were obtained from nationwide registries for information on number of deaths and age-specific mean population in each year by gender. Results The crude overall suicide rate during the last 10 years was 12.2 per 100 000 persons per year (95% CI 7.4 to 18.1), while the crude overall rate due to road traffic injuries was 4.6 per 100 000 persons per year (95% CI 2.0 to 8.3). Among men, suicide rates decreased, however not significantly (r(19)=-0.22, p=0.36), and for overdose by narcotics the rates increased significantly (r(19)=0.72, p, The study was supported by grant from Landspítali–the National University Hospital Research Fund, grant number 311055-2249.

Accidental hydrocarbon poisoning encountered in children is often a cause of pneumonia without complications or sequelae. We report a new case of pneumonitis hydrocarbons complicated parenchymatous lung abscess in a child of 3 years following accidental ingestion. The particularity of this clinical case is the scarcity of previous study.

BACKGROUND: Mortality tends to be higher among people who do not work than among workers, but the impact of work-related disability on mortality has not been well studied. METHODS: The vital status through 2015 was ascertained for 14,219 workers with an accepted workers’ compensation claim in West Virginia for a low back injury in 1998 or 1999. Mortality among the cohort compared with the West Virginia general population was assessed using standard life table techniques. Associations of mortality and disability-related factors within the cohort were evaluated using Cox proportional hazards regression. RESULTS: Compared to the general population, mortality from accidental poisoning was significantly elevated among the overall cohort and lost-time claimants. Most deaths from accidental poisoning in the cohort were due to drug overdoses involving opioids. Mortality from intentional self-harm was also significantly elevated among lost-time claimants. In internal analyses, overall mortality and mortality from cancer, heart disease, intentional self-harm, and drug overdoses involving opioids was significantly associated with lost time. Overall mortality and mortality from drug overdoses involving opioids were also significantly associated with amount of lost time, permanent partial disability, and percent permanent disability. Heart disease mortality was also significantly associated with the amount of lost time. CONCLUSIONS: The results suggest that disability itself may impact mortality risks. If confirmed, these results reinforce the importance of return to work and other efforts to reduce disability.

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. RESUMO Objetivo: Descrever o perfil dos atendimentos de crianças e adolescentes vítimas de intoxicações exógenas acidentais e os fatores associados às internações hospitalares. Métodos: Foi realizado um estudo transversal com base na revisão dos registros de todas as intoxicações acidentais de indivíduos com até 19 anos de idade, atendidos no setor de toxicologia de um hospital público de referência em 2013, excluídos os acidentes com animais peçonhentos e insetos. A intencionalidade da intoxicação foi baseada nos relatos. Foram calculadas percentagens e frequências para as variáveis qualitativas, e medidas de tendência central e de dispersão das variáveis quantitativas contínuas. Foi realizada análise múltipla, utilizando regressão logística binária para identificar as variáveis associadas à internação hospitalar das vítimas atendidas. Resultados: Em 2013, foram identificados 353 atendimentos em crianças e adolescentes. A faixa etária mais prevalente foi a de zero a quatro anos (72,5%), e predominaram indivíduos do sexo masculino (55%). A maioria dos atendimentos foi de pacientes residentes na região metropolitana (83%). Noventa por cento das intoxicações ocorreram nos domicílios; 82,7% se deram pela via oral, especialmente por medicamentos (36,5%) e produtos de limpeza (29,4% de todas as intoxicações). Resultaram em internações 12,2% dos casos, ocorrendo um único óbito. As variáveis associadas à internação foram: residir fora do município sede (razão de chances [OR]=5,20; intervalo de confiança de 95% [IC95%] 2,37-11,44) e o envolvimento de mais do que uma substância na intoxicação (OR=4,29; IC95% 1,33-13,82). Conclusões: O ambiente doméstico é o principal local em que ocorrem as intoxicações em crianças e adolescentes, especialmente por ingestão de medicamentos e produtos de limpeza e abaixo de quatro anos de idade. Esses achados justificam a priorização de ações preventivas direcionadas para esse perfil de acidentes.

Accidental pediatric poisoning (APP) is an important public health issue in both the developed and developing parts of the world. It continues to affect a number of children, but in Pakistan and other low- and middle-income countries (LMICs), few measures have been taken to counter it. As many of these children present to the Emergency Department (ED), the aim of our review was to analyze the biomedical literature regarding childhood-related accidental poisoning in general and in Pakistan and similar countries, in particular, with an emphasis on their emergency departments. We focused on children aged 0–5 years. This attempt was intended to be a first step toward gaining a better grasp of the epidemiology, following which we wish to suggest a simple management strategy. Additionally, we aim to identify the most common accidentally ingested agents in young children in Pakistan and assess the risk factors for poisoning and the efficacy of possible interventions. Given that accidental ingestions are entirely avoidable, we have focused on preventative steps and treatment. We thus present suggestions in this perspective piece for tackling the problem in resource-limited countries in general, where there is an urgent need for it.

Introduction: Poisoning in children is a common and preventable cause of morbidity and mortality. Our environment is still not child-safe and the medications are not dispensed in a child-safe manner. The incidence of childhood poisoning in India varies from 0.3 to 7.6 percent. Poisoning accounts for 0.03% of mortality in infants, 0.16% in preschool age group and 0.37% of in five to fourteen year’s age group as per the statistics projected by Government of India. The poisoning in paediatric age group includes obsolescent traditional poisons, the in fashion intoxications with recreational drugs as well as chronic exposure to industrial chemicals. The peak incidence of accidental overdoses is in the second year of life and 85% of accidental poisoning affect children under five years of age. Methodology: This is a prospective case controlled study done over a period of two years. The study was conducted in S C B Medical College, Cuttack, Odisha. Results: The poisoning constitutes 1.15% of total paediatric admissions. The commonest type of poisoning was due to Non-Medicaments (56 cases – 78.87%), out of which the commonest poisoning was due to hydrocarbons. Conclusion: Non medicament ingestions particularly kerosene still one of the very common toxic ingestion in children used in accidental poisoning cases.

Introduction: Poisoning in pediatric age group became a challenging emergency in world that might be accidental, incidental or with snake bite or scorpion sting. In spite of many measures proposed by several organizations still the cases of poisoning are increasing. Methods: In this study above 1 month to 18 years of age children were included. Cases of food poisoning, allergic drug reactions were included along with scorpion sting and snake bite. Various parameter analyzed were age, sex, time of ingestion, type of poison, signs and symptoms, time taken to reach hospital, treatment offered, and complications underwent by the patient. Results: All the children who came with complaints of poisoning were admitted in the PICU. Total PICU admissions for 2 years were 693 out of which 27 cases were poisoning. Of total admissions 3.89% were poisoning cases. In total poisoning cases admitted female are 12 and males were 15. Accidentally ingested poisoning cases were 13, intentional ingested were 4 and poisoning due snake bite were 3, scorpion sting were 7. In accidental ingested poisoning 1 is by Datura seeds. Poisoning by ingestion was of total 17 cases and other (scorpion sting and snake bite) are 10. On comparing with age 1-5 years children were more effected i.e, 15. Conclusion: It is retrospective study which showed accidental poisoning is commonly seen in under 5 age group children and incidental poisoning seen in above 10 age group children. In both groups parental counselling and safety measures improve the outcome. Early intervention of pediatric poisoning decreases morbidity and mortality in children.

Background: Childhood poisoning is a significant public health problem. It is a common worldwide health problem and a preventable cause of morbidity and mortality. Epidemiological studies on accidental poisoning in children show a consistent pattern with respect to sex and age. Aims and Objectives: To determine the changing pattern of clinical profile and outcome of acute poisoning in children and adolescent. Materials and Methods: All children aged 1-18 years with h/o poisoning, attending pediatric and medicine emergency department of College of Medicine and Sagore Dutta Hospital, Kolkata from March 2014 to February 2016 were the subjects of our study. Profiles of all cases and their outcome were noted. Results: Seventy-five patients were presented with acute poisoning during our study period. Majority of the children were between 12 to 18 years (45 cases, 60%). Most of the patients were residents of urban areas. Most frequent agents were drugs (44%), hydrocarbon (21.33%) and insecticides (22.66%). Almost all cases in 1-6 years age group were accidental in nature. Conclusion: Poisoning in children and adolescents are common problems. Incidences of acute poisoning in childhood remained more or less unchanged temporally. Poisoning by agents like drugs and organophosphorus compounds are alarming phenomena and these occur mostly during adolescence. Free availability of these compounds, co-morbid conditions of adolescents and adolescent stressors have to be addressed in this respect. Asian Journal of Medical Sciences Vol.8(3) 2017 76-80

Medical rescue teams might be exposed to the risk of accidental poisoning while performing rescue procedures. Exposure to the risk of lethal carbon dioxide (CO2) concentrations is a rare situation. This case study describes rescuing a patient who suffered from sudden cardiac arrest due to accidental CO2 poisoning. The victim was finally evacuated and resuscitated, but the circumstances of the rescue operation point to the need to equip ambulances with carbon dioxide detectors and hermetic oxygen masks. Med Pr 2017;68(1):135-138.

The topic of this paper relates to the study of cases involving the use of new psychoactive substances (NPS) from the classes of synthetic cannabinoids and cathinones, analyzed from multiple viewpoints including clinical and medico-legal perspectives. The paper investigates three fatal cases in which UR-144 and UR-144 with pentedrone identified in the bodies of victims during post-mortem examinations were responsible for the tragic consequences and proved to be the indirect cause of death. The victims were men aged 16, 22 and 40 years who used drugs, for example they smoked marijuana or its substitutes in the form of synthetic cannabinoids. In addition, all of them had behavioural problems. On account of emotional imbalance attributable probably to the presence of UR-144 (in one case) and a mixture of UR-144 and pentedrone (in the other two cases), two men committed suicide by jumping from a height and hanging, and one man had fatal accidental poisoning with pentedrone which was used to enhance the effect of previously used UR-144. The presence of UR-144 and pentedrone in the post-mortem material was analyzed by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS). The results of toxicological tests were analyzed with a focus on possible tragic side effects caused by the presence of UR-144 and UR-144 with pentedrone in the body.Temat niniejszej pracy wpisuje się w nurt badawczy dotyczący przypadków przyjmowania nowych substancji psychoaktywnych (NSP) z grupy syntetycznych kannabinoidów i katynonów, rozpatrywanych z różnych punktów widzenia, w tym w aspekcie klinicznym i medyczno-prawnym. Analiza obejmuje trzy przypadki śmiertelne, w których obecność UR-144 oraz UR-144 z pentedronem w organizmie ofiar, wykazana w toku badań pośmiertnych, zaważyła na tragicznych konsekwencjach, stając się pośrednią przyczyną zgonu. Ofiarami byli mężczyźni w wieku 16, 22 i 40 lat przyjmujący narkotyki, w tym palący marihuanę lub jej zamienniki w postaci syntetycznych kannabinoidów, którzy dodatkowo mieli problemy behawioralne. W wyniku zaburzenia równowagi emocjonalnej spowodowanej zażyciem UR-144 (w jednym przy­padku) lub mieszaniny UR-144 i pentedronu (w dwóch przypadkach) w dwóch przypadkach doszło do zamachów samobójczych w postaci skoku z wysokości i powieszenia, a w jednym do przypadkowego zatrucia śmiertelnego pentedronem zażytym w celu wzmocnienia efektu działania wcześniej przyjętego UR-144. Oznaczenie UR-144 i pentedronu w badanym materiale sekcyjnym przeprowadzono metodą chromatografii cieczowej sprzężoną z tandemową spektrometrią mas z jonizacją poprzez rozpylanie w polu elektrycznym (LC-ESI-MS-MS). Wyniki badań toksykologicznych analizowano w kontekście możliwych tragicznych efektów ubocznych obecności UR-144 oraz UR-144 z pentedronem w organizmie człowieka.

Amatoxins commonly found in Amanita phalloides is the main constituents of toxins present in most toxic mushroom specimens containing α-amanitin,β-amanitin,γ-amanitin,ε-amanitin,amanin,amaninamide,amanullin,amanullinic acid, and proamanullin.RP-HPLC analysis of toxins Chromatography:The method of Ismail Yilmaz et.al,is followed using C18 (Agilent Technologies) at UV detection 303nm for amatoxins and 291nm for phallotoxins.The mobile phase in isocratic pump with a flow rate of 1ml/min consisting of 0.05M ammonium acetate (pH 5.5 with acetic acid) and acetonitrile (90:10v/v).The geographical variations determine the content of the toxins and it brings a landmark to create awareness to the community for such mushroom specimens.We hope that analyzing the toxin content in the coming years will be of great service to the Physician and the community as well.

Dieffenbachia is a tropical ornamental house plant. Accidental ingestion of the leaf or its seed can cause serious gastrointestinal and respiratory symptoms requiring emergency treatment. An eight-year-female child was admitted to the emergency department with sudden numbness on her tongue, lower lip swelling and redness, slurred speech and difficulty breathing. Upon further interview, it was revealed that five minutes prior to these symptoms occurred, the patient was playing with the soil of dieffenbachia with a pen and placing this pen in her mouth. Symptoms resolved after treatment with antihistamines and steroids. Training of families and children about toxic effects of Dieffenbachia which is widely used as a potted house plant is very important as chewing the plant results in life-threatening consequences.

Cassia occidentalis is an annual tropical shrub causing toxicity in cattle. However, human case reports of its poisoning are scarce. We, here, report three young children, residents of Western Uttar Pradesh in North India, who presented with lethargy, jaundice, and altered sensorium after consumption of Cassia seeds. The toxidrome was defined as hepatomyoencephalopathy. The children were resuscitated, managed for acute liver failure, and subsequently discharged without sequel. Although few studies have previously documented this association, this is the first such case series documenting a direct causal relationship of Cassia to hepatomyoencephalopathy syndrome. Public and clinician awareness regarding this syndrome mimicking viral encephalitis has the potential to prevent further outbreaks.

Harms related to opioid use (whether prescribed or obtained illicitly) represent a growing cause of concern in developed countries, including Australia and Canada.This report examines the characteristics of opioid-related care visits to emergency departments (EDs) or hospital admissions and groups them into five distinct harm profiles. These profiles and their respective distributions illustrate how opioid-related harms differ across care settings in Canada. Opioid dependence and accidental poisoning were the more prominent types of harm seen in EDs, with a rate of 39.2 and 38.0 visits per 100,000 population, respectively. Within the in-patient population, rates of hospital stays were comparatively higher (26.8 per 100,000) for adverse drug reactions compared to other opioid-related harms. In addition to differing patterns in care settings, these harm groups differed on length of hospital stay, types of care received, other drugs involved and demographic variables such as age, gender and income.