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Shiitake mushrooms (This observational study is a retrospective review of cases in the French PCCs database between 1 January 2014 and 31 December 2019. Out of 125 shiitake exposures, we identified 59 cases of dermatitis: sex ratio of 1.80 M/F; ages ranging from 19 to 69 years (median: 39 years). Dermatitis occurred after raw or undercooked shiitake consumption (e.g., from the wok, in soup, or on pizza). The rash appeared 1-168 h (median: 48 h) after shiitake ingestion. Linear, erythematous, urticarial papules and plaques developed across the trunk, arms, and legs within a few hours and persisted for 1-40 d (median 10 d). The amount of shiitake eaten (lowThe mechanism of shiitake dermatitis is thought to involve lentinan, a heat-labile polysaccharide component. Inadequate cooking clearly seems to be a driver of the occurrence of shiitake dermatitis. This study highlighted a dose-dependent response, suggesting a partial toxic mechanism or a th1-type hypersensitivity mechanism. Treatment is focused on symptom management. Health professionals and the general population should be aware of both the risk associated with inadequately cooked shiitake consumption and the favourable prognosis of this still poorly known toxic dermatitis.

Data regarding immediate-release (IR)-tramadol exposures in children remain sparse. We aimed to investigate the incidence of IR-tramadol exposures in ≤6-year-old children, to describe the characteristics and resulting outcome of ingestions involving IR-tramadol alone, and to estimate a clinically relevant toxic dose in this population.Retrospective analysis of IR-tramadol exposures in ≤6-year-old children, collected by the French Poison Control Centers (PCCs) in 2003-2019. The incidence was estimated using IR-tramadol 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 1260 IR-tramadol exposures in ≤6-year-old children. The number of cases per 100,000 IR-tramadol-treated patients increased over time (Despite increasing tramadol prescriptions in adults during the study period in France, oral exposure to IR-tramadol in ≤6-year-old children was rare but possibly responsible for severe toxicity. Children with no underlying disease and concomitant medication ingesting7.4 mg/kg IR-tramadol alone could be observed at home. However, given the observed variability in the onset of seizures after tramadol ingestion, which can occur at ingested tramadol doses below 7.4 mg and even at therapeutic doses, parents or guardians should be specifically warned about the risk of seizures.

Rationale Superabsorbent polymers are marketed as toys, and cases of ingestion in children are increasingly reported. Even if these cases are usually considered benign, bowel obstruction has been reported. Objective To investigate the exposure characteristics, clinical presentation, management, and outcome of patients who developed bowel obstruction following ingestion of superabsorbent polymer-made products. Methods Databases were searched (no start date - 2020/01/31) using the following keywords: ("superabsorbent" OR "polymer" OR "hydrogel" OR "crystal" OR "jelly" OR "Orbeez" OR "beads") AND ("ingestion" OR "obstruction" OR "perforation") AND ("intestinal" OR "bowel"). All cases of bowel obstruction following superabsorbent polymer-made product ingestion were included. Results Report selection: We found 25 reports reporting 43 cases of bowel obstruction following superabsorbent polymer-made product ingestion. All the reports were retrospective, including 20 case reports and 4 case series. Patient characteristics and clinical presentation: Age ranged from 6 to 36 months, and the female/male sex ratio was 1.3. The median delay between the ingestion of the product and the onset of the first symptoms (available in only four reports) was 1.0 [0.7;1.8] day (from 15 h to 2 days). The median delay between the onset of gastrointestinal symptoms and hospital admission, available for all but 15 patients, was 3 [2;4] days (from 15 h to 30 days). The reported symptoms were persistent vomiting in all cases, associated with constipation (11/43), diarrhea (1/43), abdominal pain (1/43), and clinically assessed dehydration (14/43). Abdominal palpation found abdominal tenderness or distension in 11/43 and 28/43 patients, respectively. An abdominal mass was palpated in 3/43 patients. Two patients presented with fever, and three patients developed seizures. Characteristics of exposure: Ingestion of superabsorbent polymer-made products was reported by relatives on hospital admission in only 10/43 cases. Based on imaging and/or surgically/endoscopically removed products, all were bead-shaped objects. The median number of beads removed (available in 27/43) was 1 [1-2] (range from 1 to 6). Their median diameter (available in 21/43 patients) at the time of the diagnosis of bowel obstruction - i.e., at hydrated state - was 30 [30;36] mm (range from 25 to 65 mm). Imaging findings: Abdominal radiography, performed in 31/43 patients, never showed evidence of foreign body ingestion Abdominal computed tomography scanning, performed in 10/43 patients, visualized an intraluminal mass in 5/10 cases. Abdominal ultrasound performed in 34/43 patients allowed visualization of a rounded intraluminal image that corresponded to a bead in 28/34 patients but led to a correct diagnosis of foreign body-induced bowel obstruction in only 15/34 cases. One case reported the contributory use of abdominal MRI. Beads were always located in the small bowel (from the duodenum to the terminal ileum). Removal of beads: Bead removal required endoscopy in 2/43 cases and surgery in 41/43 cases (enterotomy or resection in 36/43 and 5/43 cases, respectively). In 3/36 cases, additional enterotomy was performed to remove beads that had not been found during the first surgery. The delay between the onset of gastrointestinal symptoms and removal procedures ranged from 1 to 7 days. Outcome: Except for two fatal cases, the outcome was favorable. Conclusions Ingestion of superabsorbent polymer-made beads can be responsible for fatal bowel obstruction in children related to the increase in bead size within the intestinal tract. Diagnosis is made difficult by the radiolucent properties of the beads. The management of bowel obstruction probably most often requires endoscopic or surgical procedures. Children under 4 years of age are probably the most at risk of developing bowel obstruction.

Summary Introduction Cases of ingestion of superabsorbent polymers (SAPs) marketed as ornamental products and toys are increasingly reported. Objective The objectives of this study were to describe the trend and outcome of SAPs beads ingestion in France. Methods We conducted a retrospective descriptive study over a 10-year period of all cases of SAPs beads ingestion collected by the French Poison Control Centers. Results In total, 193 cases of SAPs bead ingestion were collected, 90% of whom among children (median 30 months). More than 75% of cases were asymptomatic while the remaining cases exhibited minor/mild gastrointestinal symptoms. The outcome was spontaneously favorable in all cases except for one fatality in a 18-month-old girl who developed bowel obstruction. Conclusions SAPs beads ingestions were mostly asymptomatic but could be responsible for fatal bowel obstruction in children, related to the increase in SAPs beads size within the intestinal tract. The diagnosis was made difficult by SAPs radiolucent properties. SAPs bead ingestion should be considered by practitioners as a possible cause of obstruction with no foreign body found.

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

International audience; INTRODUCTION: In recent years, the number of patients managed by poison control centres (PCCs) has increased without a proportional increase in the number of physicians. To improve efficiency without neglecting patient follow-up, some PCCs have begun using text messages. We evaluated the difference in response rates between text messaging and traditional telephone follow-up. MATERIALS AND METHODS: This retrospective, monocentric, non-randomised cohort study was conducted using data from calls made by the New Aquitaine PCC between February 27, 2019, and March 31, 2019. Patients were contacted up to three times by a phone call or short message service (SMS). RESULTS: For the analysis, 823 patients were included. At the end of follow-up, the response rates were similar in the phone call and SMS group (94 vs. 94%; p = 0.76) with median [interquartile range] response times of 0 min [0; 27 min] and 29 min [6; 120 min], respectively. The response rates did not differ in subgroups stratified according to sex, self-poisoning vs. relative response, age class, and solicitation during working hours vs. outside of working hours (all p > 0.5). Moreover, health practitioners required 2.4-fold more time to call than to send text messages (p

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...

5-MeO-DALT or 5-methoxy-N,N-diallyltryptamine is a derivative of tryptamines, consumed for its hallucinogenic and entheogenic effects. We report the case of a 46-year-old-man, presenting with a brief loss of consciousness and visual hallucinations, after the consumption of three 5-MeO-DALT tablets bought online. Liquid chromatography coupled to tandem mass spectrometry method was performed, and 5-MeO-DALT was quantified in both the tablets (32.5 mg per tablet, 11% of purity) and the patient’s plasma (7 ng/mL—8 h between the consumption and the blood sample). 5-MeO-DALT poisonings are rarely described. Given the broad availability of these products, it is important that emergency department physicians and clinical toxicologists do not overlook the possibility of the ingestion of recreational tryptamines, especially since they are not detected by most routine toxicological screening.

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).

"Chiniy-tref" (CT) is a traditional preparation used in folk medicine in Martinique Island (French West Indies) that is nowadays mainly taken orally to prevent or act against any "manifestation of evil". CT is easily prepared at home by macerating larvae of the endemic swallowtail Battus polydamas (ssp.) cebriones (Dalman, 1823), sometimes accompanied by a leaf of its host-plant Aristolochia trilobata L., in commercial rum. We have previously reported the detection of nephrotoxic and carcinogenic aristolochic acids (AAs) I and II in CT, leading the Regional Health Agency (ARS) of Martinique to issue an alert regarding the potential risks associated with its consumption in 2015. In order to complete the toxicity risk assessment for oral consumption of CT, a full qualitative analysis of AAs and their analogues (AAAs) was performed, as well as a quantitative determination of the major AAs, namely AAs I and II. The phytochemical profiling of AAAs present in CT, that also corresponds to that of B. polydamas cebriones larvae feeding on A. trilobata, has been established for the first time by ultra-high performance liquid chromatography/electrospray ionization quadrupole time of-flight tandem mass spectrometry. AAs I and II were quantified in a small panel of tinctures by using a validated UHPLC/UV method, allowing us to estimate the probable daily intakes of these toxins by CT consumers. The results proved the existence of a real risk of renal toxicity and carcinogenicity associated with the chronic oral consumption of CT in Martinique, and more generally of similar "snake bottles" throughout the Caribbean.

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.

Objectifs La strychnine est un alcaloide toxique utilise depuis le 15e siecle comme rodenticide ; son utilisation est interdite en France depuis 1999 [1] , [2] . Cependant, des cas souvent mortels sont toujours signales, notamment aux centres antipoison. En janvier 2020, le centre antipoison etait contacte pour un cas de suicide avec 5 g d’une poudre contenue dans un vieux flacon pharmaceutique identifie : « strychnine sulfate neutre » ; le patient est decede. Notre travail a pour objectif de decrire les cas d’intoxication par la strychnine rapportes aux centres antipoison francais. Methode Nous avons conduit une etude multicentrique non-interventionnelle a partir des donnees des centres antipoison francais entre le 01/01/2007 et le 30/09/2019. Les dossiers ont ete selectionnes par la recherche du mot-cle « strychnine » dans les observations, des agents d’exposition qui contenaient de la strychnine ou des dossiers suspectes d’etre des intoxications a la strychnine pour lesquels une strychninemie etait positive. Les dossiers exclus etaient des demandes d’information sans exposition, des dossiers impliquant des animaux, des expositions a des produits qui ne contenaient finalement pas de strychnine ou qui n’etaient pas clairement identifies, egalement en l’absence de strychnine dans le sang (ou non detectable ou non quantifiable) avec des agents non-identifies ou enfin lorsque l’exposition etait mise en doute. Resultats Il a ete possible de selectionner 280 dossiers, dont 186 ont ete exclus. Au final, 94 cas ont ete retenus et analyses. L’incidence moyenne etait de 7,2 ± 3,4 cas par an, relativement stable dans le temps. L’âge median etait de 54 ans avec un sex-ratio de 2,36 (H/F). La circonstance etait tres souvent volontaire (72 cas soit 78 %), resultant le plus souvent d’une conduite suicidaire (71 cas soit 92 % des cas volontaires), 1 cas etait d’origine criminelle et 1 cas etait de circonstance indeterminee. Quinze patients sont decedes (14 %), 10 (68 % des decedes) l’ont ete sur place avant l’arrivee des secours. Sur les dossiers selectionnes dans notre etude, les symptomes etaient les suivants : myoclonies (23 cas soit 25 %), convulsions (20 cas soit 21 %), vomissements (20 cas soit 21 %), hypertonie generalisee (19 cas soit 20 %) et des symptomes cardiovasculaires : arret cardiaque (19 cas soit 20 %). Une strychninemie s’est revelee positive dans 13 cas (soit 14 %), le prelevement avait lieu entre 2,2 et 41 h apres l’exposition et les concentrations seriques s’echelonnaient entre 0,067 et 1,8 mg/L. Les techniques de dosage n’etaient pas mentionnees dans les dossiers. Conclusion L’intoxication par la strychnine est un evenement relativement rare mais qui reste present a bas bruit d’annee en annee avec une certaine constance. Meme si ce produit est interdit sur le territoire, il reste facile a obtenir sur internet ce qui augure une probable continuite des expositions. Theoriquement les symptomes debutent 15 a 30 minutes apres l’ingestion par la survenue brutale d’une hyperexcitabilite musculaire, avec des contractures declenchees a la moindre stimulation, un trismus, un opisthotonos puis des convulsions generalisees. Une rhabdomyolyse et une acidose lactique secondaire sont decrites. Le patient decede generalement d’une defaillance multiviscerale (respiratoire (asphyxie), cardiaque, renale et cerebrale) [2] , [3] . Les centres antipoison apportent une claire plus-value dans leur prise en charge, en particulier car l’intoxication est rare, severe et mal connue.

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.

The aim was to assess the impact of the COVID-19 pandemic on French Poison Control Centre (PCC) call characteristics. Reported cases of xenobiotic exposures from 1 March to 30 April in 2018, 2019, and 2020 were extracted from the French National Database of Poisonings. The collected data included call, patient, and exposure characteristics for both general calls and for calls involving sentinel xenobiotic categories related to the COVID-19 pandemic. The 2020 exposures were compared to 2018–2019 exposures by using simple logistic models in order to provide effect size with odds ratios. From March to April 2020, 32,182 exposures were reported to French PCCs with an overall increase of 5.6% compared to exposures in the same time frame in 2018–2019. A similar increase in calls was observed in non-epidemic and epidemic COVID-19 areas with an increase in calls from the public (+13.6%) while calls from health-professionals decreased (−7.5%). Despite the increase in exposures, the incidence of symptomatic exposures remained stable (−0.4%) with a decrease in severity (moderate/severe −17.2%). A significant increase in exposures to home cleaning products containing biocides, essential oils, and alcohol-based hand sanitizers (odds ratio >1.3, p The COVID-19 pandemic altered calls to French PCCs with a small increase in calls during the study period and changes in the pattern of exposure. These changes possibly reflected the indirect consequences of the COVID-19 pandemic i.e., limited access to primary care, fear of contracting COVID-19 and anxiety related to home isolation.

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.

International audience; Cases of human envenomation by Centruroides pococki are exceptionally reported in human. We report a Class III human envenomation by C. pococki in Guadeloupe, French West Indies, with neuromuscular toxicity that has never been described before. Symptoms resolved within a few hours, without the need for intravenous scorpion-specific antivenom.

Holothurians are marine invertebrates also known as sea cucumbers. They are used in fresh or dried forms in various cuisines around the world and have alleged medicinal properties. Consequently, sea cucumbers, notably the orange-footed sea cucumber (Cucumaria frondosa)are increasingly harvested from the environment or farmed via aquaculture. We report three cases of unusual occupational exposure to C. frondosa resulting in cutaneous, respiratory and ocular irritating symptoms. These symptoms occurred as sea cucumbers were cut on half and eviscerated manually, following a machine breakdown in a sea cucumber processing factory. Given the composition of holothurians, these symptoms probably resulted from the aerosolization of various holothurins, saponins secreted by sea cucumbers as mean of defense. Treatment was solely symptomatic and included decontamination of the skin and the eyes, inhaled glucocorticoids, anticholinergic agents and oral glucocorticoids. As the exposure resulted from a machine breakdown, no specific protective equipment was put in place. Employees were advised not to handle manuallythe sea cucumbers in case such a breakdown was to happen again.

On 15th April 2019, Parisians watched in shock as Notre-Dame de Paris, the iconic cathedral that has towered over their city for almost 900 years, was engulfed in flames. Although flames destroyed the spire and considerably weakened the structure, no human lives were lost. However, as some amounts of lead volatilized and deposited in the surrounding areas, fears of potential intoxication began to rise. We investigated the impact of this fire on the blood lead levels of adults in Paris according to the distance between the cathedral and where they live or work. The geometric mean of blood lead levels of the study population was 1.49μg/dl (95% CI [1.38–1.62]) with a prevalence of blood lead levels≥5.0μg/dL of 5.0%. Despite the early legitimate fears of intoxication, the fire that destroyed a significant part of the Notre-Dame cathedral did not increase the blood lead levels of adults living and working in the vicinity.

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.

Introduction : De fortes precipitations en mai 2016 ont provoque une crue de grande ampleur de la Seine et de ses affluents. L’analyse de cet evenement exceptionnel a montre qu’il est susceptible de se reproduire et a plus grande echelle. Les consequences sanitaires ont ete moins abordees notamment la survenue d’intoxications collectives accidentelles par le monoxyde de carbone (CO) dues a une source inhabituelle : l’utilisation de pompes de drainage a moteur thermique.Methodes : Les affaires d’intoxication collective par le CO dues a l’utilisation de pompes de drainage au printemps-ete 2016 ont ete recherchees retrospectivement dans la base de donnees du systeme regional de surveillance des intoxications oxycarbonees en Ile-de-France.Resultats : Cinq affaires ont ete identifiees. Au total, on denombrait 45 personnes exposees dont 34 intoxiquees, cinq non intoxiquees et six personnes pour lesquelles les donnees ne permettaient pas de conclure. Trois personnes ont presente des signes de gravite et deux ont beneficie d’une oxygenotherapie hyperbare. Les autres intoxiques ont ete pris en charge en milieu hospitalier et traites par oxygenotherapie au masque. Tous ont gueri.Discussion : Lors d’inondations, les intoxications collectives par le CO sont des evenements sanitaires frequents et potentiellement graves, qui peuvent survenir pendant l’evenement ou dans les jours qui suivent. Une meilleure sensibilisation des professionnels, ainsi qu’une meilleure information, voire l’usage de detecteurs de CO lors de la location d’appareils a moteur thermique a des particuliers, permettraient de prevenir ces intoxications lors de futures catastrophes climatiques.

Objectif Les surdosages medicamenteux par erreur de prescription, de dispensation, de dilution ou d’administration sont plus frequents en pediatrie, notamment en raison de la forme galenique non adaptee a une posologie de petit poids corporel. Nous rapportons trois cas de surdosage en phosphates inorganiques dont un fatal, dans le contexte d’une hypophosphoremie. Une telle supplementation est necessaire chez le nouveau-ne, notamment dans un contexte de prematurite. Methode Recherche des cas dans la base nationale des cas du systeme d’information des centres antipoison. Description des cas cliniques et du mecanisme d’action toxicologique ( Tableau 1 ). Description des cas/Discussion Les donnees cinetiques du phosphore restent encore mal connues chez l’homme ; une etude au 32P* chez le porc evalue le pic d’absorption a 1 h et la demi-vie d’elimination a 4 h avec une biodisponibilite de 71 % [1] . Un surdosage conduit a une perturbation majeure de l’equilibre phosphocalcique. L’augmentation de la phosphoremie s’accompagne d’une hypocalcemie profonde par la formation de phosphate de calcium insoluble. L’intoxication aigue conduit principalement a des atteintes hepatique, renale et neurologique avec convulsions, contractures musculaires et spasme glottique. Les effets cardiaques associent troubles du rythme (extrasystoles ventriculaires, tachycardie et/ou fibrillation ventriculaire, torsades de pointes), troubles de la conduction (QTc allonge, phenomenes de re-entrees), diminution de la force contractile du myocarde conduisant a une defaillance cardiaque aigue voire a une dissociation electro-mecanique [2] . Conclusion Les surdosages en phosphates inorganiques sont rares mais de pronostic severe. Les consequences de l’hyperphosphoremie sont celles de l’hypocalcemie profonde induite, conduisant a des troubles metaboliques, neuromusculaires et cardiaques severes. La survenue d’erreur de dosage, par l’utilisation des formes medicamenteuses non destinees a l’enfant reste difficile a ecarter totalement. Lorsqu’un fractionnement ou une dilution extemporanee est inevitable, un protocole strict et consensuel et un double controle paraissent utiles pour les prescripteurs et les soignants.

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.

Introduction En France, la pregabaline est largement prescrite chez l’adulte, mais ne dispose pas d’autorisation de mise sur le marche chez l’enfant. Nous souhaitions evaluer l’incidence des expositions a la pregabaline seule chez les enfants de 6 ans et moins, decrire les caracteristiques et les evolutions de ces ingestions et estimer une dose toxique pour cette population. Methde Analyse retrospective des cas d’exposition a la pregabaline chez les enfants ≤ 6 ans, collectes par les CAP entre 2004 et 2019, le Poison Severity Score (PSS) a ete utilise pour evaluer la gravite. L’incidence a ete estimee en utilisant les donnees de prescription du reseau Health Improvement Network. Resultats Nous avons trouve 313 cas d’expositions accidentelles a la pregabaline, chez les enfants ≤ 6 ans, dont 126 cas impliquant de la pregabaline seule (âge : 2 ans [1,6-3,0] ; dose ingeree mediane : 6,4 mg/kg [3,6-10,9]). Le nombre de cas augmentait de maniere statistiquement significative avec le temps, tout comme les prescriptions chez l’adulte (p Conclusion Malgre l’augmentation des prescriptions de pregabaline chez l’adulte en France, les expositions accidentelles restent rares chez les enfants ≤ 6 ans, et entrainent une toxicite minime. Les enfants sans antecedents neurologiques/cardiaques et sans traitement concomitant, ingerant une dose

Objectifs Estimer une dose toxique cliniquement pertinente chez les enfants ≤ 6 ans exposes involontairement au tramadol a liberation immediate (LI). Methode Analyse retrospective des expositions uniques au tramadol a liberation immediate chez les enfants ≤ 6 ans, recueillies par les centres antipoisons francais entre 2003 et 2019. Le score de gravite du poison (PSS) a ete utilise pour classer la gravite. Resultats Nous avons trouve 563 expositions uniques non intentionnelles au tramadol LI chez les enfants ≤ 6 ans. Nous avons analyse 144 cas impliquant le tramadol seul (âge, 3 ans [1,9–3,0] (mediane [25–75e percentiles]) ; dose mediane ingeree 5,3 mg/kg [3,3–11,3]). Quatre-vingt-deux intoxications (57 %) etaient liees a des erreurs therapeutiques impliquant des gouttes de tramadol a liberation immediate. Aucun enfant n’avait de maladie neurologique/cardiaque sous-jacente. La moitie des enfants est restee asymptomatique (PSS0) tandis que 31 % (n = 44), 11 % (n = 16) et 8 % (n = 12) ont developpe des symptomes mineurs (PSS1), moderes (PSS2) et severes (PSS3), respectivement. Nous avons observe des symptomes neurologiques moderes a severes (PSS2-PSS3) chez 19 enfants (coma, depression respiratoire, apnee, troubles de la conscience moderes). Nous n’avons pas observe de crises d’epilepsie ni de deces. Aucun dosage interpretable n’etait disponible pour les cas moderes a severes. Nous avons trouve une correlation positive entre la dose de tramadol LI ingeree et le PSS (p Conclusion Chez les enfants ne presentant pas de maladie neurologique/cardiaque sous-jacente ni de medicaments psychotropes concomitants, l’ingestion de > 7,4 mg/kg de tramadol LI seul permet de predire l’apparition de symptomes neurologiques moderes a severes.

Objectifs Valider le dosage simultane de 4 metaux (Pb, Cd, Hg et As) en utilisant le dispositif hemaPEN de la societe Trajan. Methode hemaPEN est un systeme de prelevement et de depot sur disques papier d’un volume parfaitement mesure de sang capillaire. Le dispositif comporte 4 capillaires en verre de 2,74 μL, 4 disques de papier de 3,5 mm et un dessicateur permettant la conservation des disques. Au contact d’une goutte de sang, les 4 capillaires se remplissent entierement et simultanement puis, sont mis au contact des disques permettant le transfert du sang sur ces derniers. Nous avons choisi de valider 4 elements d’interet toxicologique sur sang total (Pb, As, Hg, Cd). L’extraction utilise 400 μL d’une solution comprenant Triton X-100 0,5 %, HNO3 0,05 M, rhodium 1 μg/L. Le dosage est realise par ICP-MS (NexION 2000™, Perkin Elmer) sur un disque extrait par 400 μL de solution. Pb, Cd et Hg sont doses en mode standard et As en mode DRC avec O2. Le rhodium est utilise comme etalon interne. La validation analytique a ete realisee sur des filtres avec depot a la pipette de 2,74 μL de sang. Le rapport final de dilution est de 1/145. Resultats Les conditions d’extraction retenues permettent une recuperation moyenne de 100 %, 106 %, 101 % et 99 % pour Pb, As, Cd et Hg respectivement. Les Ldq (10 sd du blanc) sont de 0,011 μmol/L (2,3 μg/L) pour Pb, 3,5 nmol/L (0,26 μg/L) pour As, 0,2 nmol/L (0,04 μg/L) pour Hg et 1 nmol/L (0,11 μg/L) pour Cd. La repetabilite sur 3 niveaux est inferieure a 10 % pour les 4 elements sauf Hg au niveau bas (14 %). L’analyse de 20 blancs « filtres » montre une contamination sans impact pour Pb, As et Hg. Pour Cd, la contamination est tres variable et depasse parfois les valeurs de reference du sang. L’exactitude, calculee par analyse de CQI, est satisfaisante pour Pb, As et Cd sauf pour les valeurs faibles de Cd en raison de la contamination des filtres. Pour Hg, elle n’est pas satisfaisante car les conditions analytiques ne sont pas celles utilisees en routine pour cet element. Dix-sept sangs veineux de plombemie connue (0,035 a 3,60 μmol/L) ont ete deposes sur des filtres et analyses. L’equation de correlation obtenue est : Pbfiltres = 1,05 × Pbroutine + 0,004, r = 0,9975. Enfin, 15 patients ont ete testes pour le plomb avec le systeme complet et compares au dosage de routine. Pour des valeurs de 0,05 a 2,38 μmol/L, l’equation de correlation obtenue est : PbhemaPEN = 0,952 × Pbroutine + 0,07, r = 0,990. Conclusion Nos resultats montrent qu’il est possible de doser avec de bonnes performances des metaux sur un volume de sang aussi faible que 2,74 μL avec un facteur de dilution 3,6 plus important que celui d’une methode de routine. Les resultats de la validation pour As et Pb sont bons et, pour Pb, satisfont les criteres exiges pour l’accreditation. On observe une excellente correlation entre les plombemies mesurees avec l’hemaPEN et le dosage de routine chez des patients. L’interet de ce type de dispositif microsampling est de disposer de 4 disques simultanement permettant soit de sensibiliser le dosage (elution de plusieurs disques) soit de doser des molecules organiques. Nos resultats valident l’utilisation de l’outil hemaPEN pour le dosage des metaux. Une application pour des etudes environnementales est en cours d’etude, necessitant la maitrise de la contamination lors du prelevement, particulierement pour le dosage du plomb.

Objectifs Documenter et decrire l’usage recreatif de la pregabaline chez les adolescents, en utilisant les donnees de la Base nationale des cas d’intoxication (BNCI) des centres antipoison (CAP) francais. Methode Analyse retrospective des cas d’intoxication volontaire aigue par la pregabaline, seule ou en association, chez les adolescents (âges [10–17]), collectes par les CAP entre 2004 et 2020. Le Poison Severity Score (PSS) a ete utilise pour evaluer la gravite. Resultats Sur la periode de l’etude, 382 cas d’intoxication volontaire aigue par la pregabaline chez des adolescents ont ete rapportes aux CAP francais. Parmi eux, 94 (25 %) etaient lies a une toxicomanie ou a un usage recreatif. Le premier de ces cas a ete rapporte en 2014, et le nombre de cas par an est reste Conclusion La pregabaline est commercialisee en Europe depuis 2004, uniquement chez l’adulte, pour la prise en charge des douleurs neuropathiques, des troubles anxieux generalises et en tant que traitement d’appoint de certaines formes d’epilepsie. Les prescriptions de pregabaline n’ont cesse d’augmenter et des signaux sur son utilisation recreative sont apparus dans le monde entier [1] , [2] . Par ailleurs, la pregabaline est en France en 2020 la plus grande contributrice d’ordonnances falsifiees et les notifications aux centres d’addictovigilance sont en augmentation [3] . La pregabaline serait utilisee a visee recreative pour ses effets euphoriques et dissociatifs [4] . L’utilisation de la pregabaline peut etre associee a une intoxication severe, notamment lorsqu’elle est co-administree avec des opioides et/ou des benzodiazepines. Cette utilisation recreative de la pregabaline chez des adolescents en contexte de precarite n’a pas ete signalee auparavant, elle est alarmante et devrait conduire a des campagnes de prevention, ciblees sur la population a risque decrite dans cette etude.