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Background: The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005. Objective: To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019. Methods: This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019. Results: A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex-unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self-harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co-ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report. Conclusion: This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.

Objective: The aim of this study was to report and analyse the poisoning data of Hong Kong Poison Information Centre in 2018. Methods: In 2018, all poisoning cases received by Hong Kong Poison Information Centre were retrieved from its database, Poison Information and Clinical Management System, for analysis. Results: A total of 3960 poisoned cases were analysed. There were 1770 male patients (44.7%), 2188 female patients (55.3%) and 2 sex-unspecified patients (Conclusion: This 13th annual report provided the updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparison with our previous reports.

Background: Stonefish sting injury is one of the common marine stings in Hong Kong. It is commonly sustained during maritime activities, and it could be regarded as occupational hazard for chefs or domestic hazard for family. Its envenomation could lead to significant local symptoms (pain or swelling) and serious complications, including infection and compartment syndrome. Objectives: This study is to review its clinical presentation and various treatment modalities. Methodology and study design: Reported cases of stonefish stings to Hong Kong Poison Information Centre from October 2008 to October 2018 were included in the study. The cases were retrieved from the Hong Kong Poison Information Centre electronic database. Information on patient demographic data, clinical parameters (e.g. the site of injury, presenting symptoms), and various treatment modalities (e.g. analgesics, hot water immersion, and use of antivenom) was collected. Results: There were 32 eligible patients included in this case series. All of them sustained the injury over either their fingers or hands. All patients reported pain over the site of injury. Other reported symptoms included numbness (41%), swelling (81%), and redness (47%). Twenty-five patients (78%) had radiograph done, and one of them was noted to have foreign body retained at the site of envenomation. All patients received hot water immersion to the affected part at 40°C–45°C for at least 30 min. Altogether eight patients (25%) received stonefish antivenom for pain relief. One patient developed compartment syndrome and received emergency operation of fasciotomy of right hand and forearm. Conclusion: Stonefish envenomation can cause extreme pain, swelling, and erythema, which can be managed with hot water immersion, analgesics, and prophylactic antibiotics. Use of antivenom can be considered in selected case.

The impact of substance use disorders (SUD) in an Asian population has not been fully explored. We aimed to assess the risk of mortality, accident and emergency (AE) department attendances, and hospital admissions associated with SUD in a population-based cohort study.Patients diagnosed with SUD in public AE departments from 2004 to 2016 (N = 8,423) were identified in the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority and 1:1 matched to patients without SUD by propensity score (N = 6,074 in each group). Relative risks of mortality, AE attendances and hospital admissions were assessed using Cox regression and Hurdle negative binomial regression.Patients with SUD had higher mortality (hazard ratio=1.43; 95% confidence interval [CI]=1.26-1.62) and more often died from poisoning or toxicity and injuries. The odds ratio (OR) for AE attendances and all-cause hospital admissions associated with SUD were 2.80 (95% CI=2.58-3.04) and 3.54 (95% CI=3.26-3.83), respectively. The impact of SUD on the above outcomes was greatest among school-aged individuals (≤ 21 years) and decreased with age. The relative risk of mental disorder-related hospital admissions was much higher than that for infections, respiratory diseases, and cardiovascular diseases. In patients with SUD, ketamine and amphetamine use were associated with increased AE attendances than opioid use.SUD was associated with increased mortality, AE attendances and hospital admissions, especially in school-aged individuals. Our findings suggest prioritising early treatment and preventive interventions for school-aged individuals and focusing on the management of comorbid mental disorders and the use of ketamine and amphetamine.

Background Children and adolescents with attention deficit hyperactivity disorder (ADHD) are at higher risk of all-cause poisoning by drugs and chemicals (intentional or accidental). Currently, there is limited data on whether medication treatment for ADHD can reduce the risk of all-cause poisoning. Methods Patients aged 5–18 years with a methylphenidate (MPH) prescription and an incident poisoning diagnosis between January 2001 and June 2020 were identified from the Hong Kong Clinical Data Analysis and Reporting System. A self-controlled case series study design was used to compare the incidence rate ratios (IRRs) of all-cause poisoning during different risk windows (30 days before the first MPH prescription, exposure periods within 30 days of the first prescription, and periods of subsequent exposure) compared with the reference window (other non-exposure periods). Results 42,203 patients were prescribed ADHD medication in Hong Kong during the study period. Of these, 417 patients who had both an MPH prescription and poisoning incident recorded were included in the main analysis. Compared with other non-exposed periods, a higher risk of poisoning was found in the 30 days before the first prescription (IRR 2.64, 95% confidence interval [CI] 1.33–5.22) and exposure periods within 30 days of the first prescription (IRR 2.18, 95% CI 1.06–4.48), but not during prolonged exposure. However, compared with 30 days before the first prescription as well as exposure periods within 30 days of the first prescription, there was a lower risk during the subsequent exposure (IRRs 0.49 and 0.60, respectively). Similar results to the main analysis were also found in the subgroup analysis of intentional poisoning and females, but not in that of accidental poisoning and males. Conclusions The risk of all-cause poisoning was higher shortly before and after the first MPH prescription and became lower during the subsequent prescription period. Our results do not support an association between the use of MPH and an increased risk of all-cause poisoning in children and adolescents and, in fact, suggest that longer-term use of MPH may be associated with a lower risk of all-cause poisoning, although this latter finding requires further study. Supplementary Information The online version contains supplementary material available at 10.1007/s40263-021-00824-x.

Background: Gelsemium elegans is an extremely toxic plant, but gelsemium poisoning is seldom reported in the English literature. Objectives: To evaluate the clinical manifestations and causes of gelsemium poisoning in Hong Kong. Methods: A retrospective review of gelsemium poisoning recorded by the Hong Kong Poison Information Centre from 2005 to 2017. Results: In total, 33 cases (55% female, median age 44 (interquartile range: 30–56)) were identified in 14 incidences. Consumption of contaminated Ficus hirta (五指毛桃) soup is the commonest cause (52%). Other causes include misidentification of herbs (12%), consumption of parasitic plant Cassytha filiformis (無根藤) (15%) and suicidal ingestion of Gelsemium elegans (斷腸草) (3%). Most patients (94%) had mild to moderate toxicity, with one fatal case and one severe case presented with coma and respiratory depression. All patients complained of dizziness (100%), followed by visual blurring (34%) and nausea (28%). More than half (53%) had ocular manifestations (e.g. visual blurring, ptosis, nystagmus, diplopia) which are not commonly reported in other herbal poisoning. The time of symptom onset was early (median: 50 min (interquartile range: 30–60)) and all occurred within 2 h after oral intake. Most patients (94%) recovered uneventfully with conservative treatment. Conclusion: Most gelsemium poisoning in Hong Kong was due to contamination or misidentification. Early-onset dizziness (

Amfetamine and methamfetamine abuse remains a prevalent health problem, increasing the burden on healthcare. Naltrexone, a µ-opioid receptor antagonist, has been suggested as a promising treatment for amfetamine and methamfetamine use disorder.To review the current evidence for the efficacy and safety of naltrexone as a pharmacological treatment for amfetamine and methamfetamine use disorder. The primary outcome was defined as abstinence or reduction of use. Secondary outcomes were, attenuated "positive" subjective effects (e.g., "feel good," "craving," etc.) of amfetamine or methamfetamine after naltrexone treatment, adverse events and physiological changes (e.g., blood pressure, heart rate).This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature search was conducted on 2 April 2017, and updated on 31 March 2018. Records were retrieved from databases including PubMed, EMBASE Classic plus EMBASE 1980 via Ovid, and the databases were searched using keywords and/or headings: (naltrexone AND amfetamine AND dependence) OR (naltrexone AND amfetamine AND craving) OR (vivitrol AND amfetamine) OR (revia AND amfetamine) OR (naltrexone AND amfetamine) OR (naltrexone AND methamfetamine dependence) OR (naltrexone AND methamfetamine AND craving) OR (vivitrol AND methamfetamine) OR (revia AND methamfetamine) OR (naltrexone AND ice) OR (naltrexone AND crystal meth) OR (naltrexone AND methamfetamine). Studies investigating the effects of naltrexone on amfetamine or methamfetamine use were eligible for inclusion. All studies were rated as low risk of bias using the Cochrane tool for risk of bias.Among 591 identified studies, there were four randomized controlled trials. Two studies investigated the effects of naltrexone on amfetamine use disorder and two on methamfetamine use. Compared to placebo, the abstinence rate was increased significantly (p 0.05) by naltrexone in one of two amfetamine studies, whereas there was no statistical difference in the only study reporting methamfetamine use. In one out of two amfetamine studies, naltrexone significantly attenuated either craving levels or subjective effects (e.g., "want more," "like effect") relative to placebo (p 0.05). Additionally, only in one of two methamfetamine studies did naltrexone produce a significant reduction (p 0.05) in craving levels or attenuated subjective effects. Both amfetamine and methamfetamine studies showed good tolerability of naltrexone, with few adverse events seen.There is presently insufficient evidence to support the use of naltrexone in amfetamine and metamfetamine use disorders. There is a compelling need for high-quality studies to further evaluate the potential use of naltrexone.

Objectives: To report and analyse the poisoning data of Hong Kong Poison Information Centre in 2017. Methods: In 2017, all poisoning cases received by Hong Kong Poison Information Centre were retrieved from its database (Poison Information and Clinical Management System) for analysis. Results: A total of 3956 poisoned cases were analysed. There were 1789 male patients (45.2%), 2159 female patients (54.6%) and 8 sex-unspecified patients (0.2%). The majority of cases (59.9%) were between 20 and 59 years old. The common causes of poisoning were suspected self-harm/suicidal attempt (36.2%), unintentional exposure (18.6%) and abusive substance use (13.7%). Excluding the common co-ingestant ethanol, the five commonest types of poison were benzodiazepines, paracetamol, zopiclone, Chinese herbal medicine and household products. Most patients were managed with supportive measures, while 17.4% and 13.2% of consultation cases were treated by decontamination and antidotes, respectively. The majority of the cases had uneventful recovery; 1.1% resulted in death and 4.3% had major outcomes. A total of 13 interesting cases and 1 poisoning outbreak were discussed. Conclusion: This 12th annual report provided the updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparison with our previous reports.

Objective: To report and analyse the poisoning data of Hong Kong Poison Information Centre in 2016. Methods: In 2016, all poisoning cases received by Hong Kong Poison Information Centre were retrieved from its database (Poison Information and Clinical Management System) for analysis. Results: A total of 4096 poisoned cases were analysed. There were 1871 male patients (45.7%), 2203 female patients (53.8%) and 22 sex unspecified patients (0.5%). The majority of the cases (63.1%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (36.3%), unintentional exposure (18.4%) and abusive use (13.1%). Excluding the common co-ingestant ethanol, the five commonest types of poisons were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 14.3% and 12.9% of them were treated by decontamination and antidotes, respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 3.9% had major outcomes. Six interesting cases and three poisoning outbreaks were discussed. Conclusion: This 11th annual report provided the updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2015. Methods In 2015, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,960 poisoned cases were analysed. There were 1,770 male patients (44.7%), 2,176 female patients (55.0%) and 14 sex unspecified patients (0.4%). The majority of the cases (63.5%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (38.4%), unintentional exposure (17.4%) and abusive substances use (11.6%). Excluding the common co-ingestant ethanol, the five commonest types of poison were paracetamol, benzodiazepine, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 16.4% and 16.2% of them were treated by decontamination and antidotes respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 4.3% had major outcomes. Seven interesting cases and one outbreak were discussed. Conclusions This 10th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.

Introduction Exotic pets are increasingly popular in Hong Kong and include fish, amphibians, reptiles, and arthropods. Some of these exotic animals are venomous and may cause injuries to and envenomation of their owners. The clinical experience of emergency physicians in the management of injuries and envenomation by these exotic animals is limited. We reviewed the clinical features and outcomes of injuries and envenomation by exotic pets recorded by the Hong Kong Poison Information Centre. Methods We retrospectively retrieved and reviewed cases of injuries and envenomation by exotic pets recorded by the Hong Kong Poison Information Centre from 1 July 2008 to 31 March 2017. Results There were 15 reported cases of injuries and envenomation by exotic pets during the study period, including snakebite (n=6), fish sting (n=4), scorpion sting (n=2), lizard bite (n=2), and turtle bite (n=1). There were two cases of major effects from the envenomation, seven cases with moderate effects, and six cases with mild effects. All major effects were related to venomous snakebites. There were no mortalities. Conclusion All human injuries from exotic pets arose from reptiles, scorpions, and fish. All cases of major envenomation were inflicted by snakes.

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2014. Methods In 2014, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,609 poisoned cases were analyzed. There were 1,587 male patients (44.0%), 2,000 female patients (55.4%) and 22 sex unspecified patients (0.6%). Middle aged group (30-39 years) was the commonest and composed of about one-fifth (20.3%) of the poisoning cases while about two-third (66.2%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (42.2%), unintentional exposure (16.5%) and abusive substances use (12.9%). Excluding the common co-ingestant ethanol, five commonest types of poison exposed were benzodiazepine, paracetamol, zopiclone, Chinese herbal medicine and household products. Majority of the patients were managed with supportive measures, and 14.7% and 15.0% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 5.0% had major outcomes. Conclusions This 9th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2015; 22:376-387)

The mainstay of treatment for significant envenoming from snakebites is antivenom. However, there is insufficient data regarding the safety of antivenom used in Hong Kong. We describe the incidence of hypersensitivity reactions from antivenom use and review the frequency and reasons for intensive care unit (ICU) admission.The Hong Kong Poisons Information Centre database was reviewed. All patients given snake antivenom between 2008 and 2015 were included. Patient demographics, species of snake involved, details of antivenom used, treatment location, use of pre-treatment, reasons for ICU admission (where applicable) and details of early and late antivenom reactions were extracted.There were 191 patients who received snake antivenom. Most (93%) were treated with either the green pit viper antivenom from Thailand or the Agkistrodon halys antivenom from China. The incidences of early hypersensitivity reactions to green pit viper antivenom and Agkistrodon Halys antivenom were 4.7% and 1.4%, respectively. Most patients (69%) were managed in the ED observation ward or general ward. There were 59 patients managed in ICU, most (90%) of whom were admitted for close monitoring during antivenom administration. There were no cases of significant morbidity from antivenom administration. Eight patients (5.6%) had features suggestive of mild serum sickness.The incidence of immediate hypersensitivity reaction to antivenom commonly used in Hong Kong is low. Majority of patients were managed safely in the emergency department observation ward or general ward. Serum sickness appears to be uncommon and possible cases presented with mild features.

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2013. Methods In 2013, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,783 poisoned cases were analysed. There were 1,595 male patients (42.2%), 2,185 female patients (57.8%) and 3 sex unspecified patients (0.1%). Middle aged group (30-39 years) composed about one-fifth (20.8%) of the poisoning cases while about two-third (66.8%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (43%), unintentional exposure (15.3%) and abusive substances use (14.5%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, household products and Chinese herbal medicine. Majority of the patients were managed with supportive measures, and 13.2% and 10.8% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 4.3% had major outcomes. Conclusions This 8th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j. emerg.med. 2014;21:249-259)

Objective To report and analyze the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2012. Methods In 2012, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis. Results A total of 4,814 poisoned cases were analyzed. There were 1,771 male patients (42.3%), 2,399 female patients (57.3%) and 14 sex unspecified patients (0.3%). Middle aged group (30-39 years) contributed about one-fifth (20.1%) of the poisoning cases while more than two-third (67.7%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (45%), abusive substances use (13.9%) and unintentional exposure (13.0%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, bites and envenomation and household products. Majority of the patients were managed with supportive measures, and 15.7% and 11.9% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.6% of the poison exposure resulted in death and 4.7% of the exposure had major outcomes. Conclusions This seventh annual report provides updated epidemiological information on poisoning pattern in Hong Kong and highlights important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2013;20:371-381)

Mushroom poisoning is a cause of major mortality and morbidity all over the world. Although Hong Kong people consume a lot of mushrooms, there are only a few clinical studies and reviews of local mushroom poisoning. This study aimed to review the clinical characteristics, source, and outcome of mushroom poisoning incidences in Hong Kong.This descriptive case series review was conducted by the Hong Kong Poison Information Centre and involved all cases of mushroom poisoning reported to the Centre from 1 July 2005 to 30 June 2015.Overall, 67 cases of mushroom poisoning were reported. Of these, 60 (90%) cases presented with gastrointestinal symptoms of vomiting, diarrhoea, and abdominal pain. Gastrointestinal symptoms were early onset (6 hours post-ingestion) and not severe in 53 patients and all recovered after symptomatic treatment and a short duration of hospital care. Gastrointestinal symptoms, however, were of late onset (≥6 hours post-ingestion) in seven patients; these were life-threatening cases of amatoxin poisoning. In all cases, the poisonous mushroom had been picked from the wild. Three cases were imported from other countries, and four collected and consumed the amatoxin-containing mushrooms in Hong Kong. Of the seven cases of amatoxin poisoning, six were critically ill, of whom one died and two required liver transplantation. There was one confirmed case of hallucinogenic mushroom poisoning caused by Tylopilus nigerrimus after consumption of a commercial mushroom product. A number of poisoning incidences involved the consumption of wild-harvested dried porcini purchased in the market.Most cases of mushroom poisoning in Hong Kong presented with gastrointestinal symptoms and followed a benign course. Life-threatening cases of amatoxin poisoning are occasionally seen. Doctors should consider this diagnosis in patients who present with gastrointestinal symptoms that begin 6 hours or more after mushroom consumption.

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2011. Methods In 2011, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis. Results A total of 4,331 poisoned cases were analysed. There were 1,915 male patients (44.2%), 2,411 female patients (55.7%) and 5 patients with sex unknown. More than two-third (68%) of them were between 20 and 59 years old. Common causes of exposure were suspected self-harm/suicidal attempt, unintentional exposure and abusive use. Paracetamol, benzodiazepine, household product, zopiclone, and Chinese herbal medicine were the top five commonest poisons encountered. Majority of the patients were managed supportively, with 12.1% and 8.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 4.8% of the exposure had major outcomes. Conclusions This 6th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2010. Methods In 2010, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis. Results A total of 4,418 poisoned cases were analysed. There were 1,863 male patients (42.2%) and 2,540 female patients (57.5%). More than two-third of cases (68.3%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Benzodiazepine, paracetamol, ketamine, zopiclone, and Chinese herbal medicine were the common agents involved. Majority of the patients were managed supportively, with 10.2% and 9.7% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 5.3% of the exposure had major outcomes. Conclusions This fifth annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

The aim of this study was to validate and compare the performance of serum paraquat level, severity index of paraquat poisoning (SIPP), Acute Physiology And Chronic Health Evaluation II (APACHE II), modified Simplified Acute Physiology Score II (MSAPS II), and modified Expanded Simplified Acute Physiology Score II (MSAPS IIe) calculated immediately after arrival on emergency department (ED) for assessing the mortality of acute paraquat poisoning.A retrospective study design was employed with the main outcome measure being mortality from year 2001 to 2010. MSAPS II and MSAPS IIe were employed in that assessment of the 24-hour urine output were not included. The performance of APACHE II, MSAPS II, MSAPS IIe, serum paraquat level and SIPP for prediction of mortality in acute paraquat poisoning were compared.A total of 102 patients were enrolled in the study. The area under the ROC curve for APACHE II (0.800) was statistically lower than those for MSAPS II, MSAPS IIe, SIPP and serum paraquat (0.879, 0.893, 0.924,and 0.951, respectively). The Hosmer-Lemeshow goodness-of-fit test C statistic revealed that APACHE II, MSAPS II, MSAPS IIe and serum paraquat level showed good calibrations (chi-square 8.477 and p = 0.388, chi-square 4.614 and p = 0.798, chi-squared 5.301 and p = 0.725, chi-squared 1.009 and p = 0.985 respectively), but poor calibration for SIPP (chi-square 21.293 and p = 0.006).Serum paraquat level is still the most reliable prognosis factor in acute paraquat poisoning. But MSAPS II or MSAPS IIe calculated immediately after arrival on ED may be helpful to predict mortality in acute paraquat poisoning especially when hospital has no facility to measure serum paraquat level.

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2009. Methods In 2009, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis. Results Totally 4338 poisoned cases were analysed. There were 1955 male patients (45.1%), 2,367 female patients (54.6%) and 16 patients with no gender specified. More than two-third of cases (68.6%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, abusive use and unintentional exposure. Paracetamol, ketamine, zopiclone, benzodiazepine and household products were the common poisons exposed. Majority of the patients were managed supportively, with 13.6% and 13.1% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Conclusions The 2009 annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

Objective Ketamine is one of the commonest abusing agents in Hong Kong. Our study aims to identify their clinical pattern of presentations to emergency departments. Method This is a retrospective survey study. The studied group was ketamine abusers being referred to us from a source out of emergency department (ED). Control group was randomly selected from patients attending our ED. The electronic records of the ketamine abusers and the controls in the past 3 years (1st April 2004-31st March 2007) were reviewed and analysed. Result Total 91 subjects (48 in ketamine group, 43 in control group) were included. The mean age of ketamine abusers and control group are 21 and 22.2 year-old respectively. Most of them (97.9%) did not declare their background of ketamine abuse. The mean 3-year attendance rate for the ketamine group was 2.38 and for control group was 0.91, with a difference of 1.47 (95% CI 0.54-2.41, p=0.003). Most of their illnesses were diagnosed as epigastric pain (25%), followed by upper respiratory tract infection (18.8%), head injury (10.4%) and urinary tract infection (10.4%). Significantly higher number of ketamine abusers presented with epigastric pain compared with control group (odds ratio 143, pConclusion Most teenage ketamine abusers do not declare their background of drug abuse when they present to emergency departments. They tend to have a higher frequency of attendances. Most of their presenting problems are related to gastrointestinal system.

Objective Hot water immersion (HWI) has been proven to be effective for the treatment of pain due to marine envenomation. Our preliminary study by simply measuring the temperature change over time on the hot water in our conventional metal tray method revealed a too rapid fall in water temperature that happened in minutes. The aim of this study was to review the current practice of HWI for patients with marine envenomation in the emergency departments in Hong Kong, and to look for the optimal equipment in performing HWI. Method We first conducted a phone survey to 16 registered nurses or nursing officers from 16 emergency departments of public hospitals in Hong Kong for the current practice of hot water immersion. The second part of our study was an in-vitro experiment done in observation room that a healthy subject immersed a hand into the water bath in metallic tray, sharp box and thermal isolator with and without covering of aluminum foil or plastic foil. The temperature change of the water bath in these containers was serially monitored. Results In our phone survey, 14 respondents used plastic tray or sharp box for hot water immersion. Nine of them claimed that they commonly encountered inadequate wound pain relief and early cooling of the hot water bath. The experiment showed that the water temperature dropped out of optimal range for 5 minutes and 15 minutes in metallic tray and sharp box respectively. The thermal isolator kept the optimal temperature throughout 30 minutes of the study time. Conclusion Our purposed thermal isolator is a safe, practical and effective device for HWI therapy.

Objective To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2008. Methods From 1st January 2008 to 31st December 2008, all poisoning cases received by HKPIC were retrieved from its database (DATOX & PIC-MS) for analysis. Results 4,029 poisoned cases were analyzed. There were 1,755 male patients (43.6%) and 2,262 female patients (56.1%). Nearly two-thirds of them were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Sedatives, household products, paracetamol, and ketamine were common poisons exposed and non-benzodiazepine sedative-hypnotics were involved in about one-seventh of the poisoning cases. The majority of the patients were managed conservatively, with 6.0% and 5.9% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Conclusions This annual report provides updated epidemiological information on poisoning in Hong Kong in 2008 and highlights some changes in comparison with our previous reports. The increase in abusive substance poisoning, in particular ketamine, requires further attention.

Introduction In drug overdose, it is generally perceived that the dosage can predict the clinical outcome. Are the dosages of intentional drug overdosing the same between day and night? If so, are these overdoses followed by similar clinical outcomes? Answers to these two questions might affect resource allocation and clinical judgment. The present study was performed to establish whether daytime patients and night time patients report similar drug doses, and see which group of patients would have a higher incidence of severe outcomes. Method A retrospective observational study on intentional drug overdose was performed. The reported numbers of total tablets ingested and the incidences of major outcomes, in terms of death and intensive care unit admissions, were compared between daytime and night time. Results A total of 400 patients were included. The reported number of ingested tablets in daytime had no statistical difference with that at night time. The numbers of severe outcomes had no differences between the patients presenting to the emergency department at daytime or night time. Yet overdosing at night time was more likely associated with severe outcomes. Conclusions We advise a higher index of suspicion at the emergency department on the reliability of the dosages reported by patients who overdose during night time. The larger number of severe outcomes may also be related to more toxic drug exposures in the night time. More resources in the community could be allocated to self-harm prevention at night time.

We report a 25-year-old man with bradycardia after administration of ophthalmic timolol. The patient was asymptomatic, and his bradycardia resolved after stopping the eye drop. He was discharged after a four-hour observation. This case demonstrated that topical timolol eye drop may cause systemic adverse reaction. The use of timolol and its possible side-effects are discussed.

Objective To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2007. Methods From 1st January 2007 to 31st December 2007, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis. Results 2842 poisoned cases were analyzed. There were 1199 male and 1610 female patients and more than two-thirds of the cases were between 20 and 59 years old. Common causes of exposure were suicidal attempt, accident and abusive use. Non-benzodiazepine sedative-hypnotic, household products and paracetamol were common poisons exposed. The majority of the patients were managed conservatively, with 8.4% and 6.4% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Conclusions This 2007 annual report provided updated epidemiological information on the poisoning pattern in Hong Kong and highlighted some changes in comparison to the situation in 2006.

ObjectiveThe purpose of this study was to evaluate the serum level of salicylate after topical application of methylsalicylate (analgesic balm), and to determine the safety of its use in our population.MethodsThis was a human volunteer study involving six volunteers. Each of them applied 10 grams of analgesic balm (containing 5 grams of methylsalicylate) on the limbs, and serial serum salicylate levels were measured just before the trial, and 1, 2, 4 and 8 hours after application. The time required to reach the maximum blood level after application was recorded.ResultsThe serum salicylate level ranged from non-detectable level up to near therapeutic level in different subjects. The maximum salicylate level measured was 130 mg/L in one of the volunteers 8 hours after application. The calculated systemic bioavailability of dermal methylsalicylate in our study was 19-45%, which was comparable to previous studies.ConclusionsDermal application of massive amount of analgesic balm may cause unpredictable absorption of methylsalicylate. Patients and physicians should be aware of its potential risk.

Objective To study the epidemiology of venomous fish sting injuries, management and clinical outcomes of injured patients reported to the Hong Kong Poison Information Centre (HKPIC). Methods All venomous fish sting cases reported to HKPIC from July 2005 to June 2008 were retrieved from its database (DATOX) and the Hong Kong Hospital Authority (HA) Electronic Patient Record (ePR) computer system for analysis. Results There were a total of 33 fish sting cases in this study. The average age of the patients was 43 years (range 20 to 84) and 24 patients were males. Most cases were injured by catfish (n=12), followed by stonefish (n=7) and lionfish (n=4). Ten cases sustained fish sting injury whilst at work. Five patients developed fish sting complications including cellulitis, subacute tenosynovitis, abscess formation and foreign body retention. No mortality was recorded. Within 7 cases of stonefish injury, 3 cases were classified as moderate effect outcome. Two patients received stonefish antivenom and none developed anaphylaxis. Conclusion The majority of marine envenomations did not result in significant morbidity and required only supportive management. However, stonefish injuries might be associated with an increased risk of severe local symptoms which therefore required aggressive treatment including antivenom.

Objective To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2006. Methods From 1st January 2006 to 31st December 2006, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis. Results A total of 2555 poisoned cases were analysed. There were 1051 male and 1466 female patients and nearly 60% of the cases were between 20 and 49 years old. Common causes of exposure were suicidal attempts and accidents. Paracetamol, sedative-hypnotic and household products were common sources of poison exposure. The majority of the patients were managed conservatively, with 18.8% and 10.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Nearly half of the cases were managed in the accident & emergency department without hospitalisation. Conclusions This annual report provides updated epidemiological information on poisoning in Hong Kong. Subsequent annual reports would provide important information on the trend of poisoning pattern and may guide further strategies in poison control and prevention in Hong Kong.

We report a 5-year-old child with fever and confusion after ingestion of a tablet of methylenedioxymethamphetamine (MDMA). He was treated successfully with supportive measures and titrated doses of benzodiazepine. In children with unexplained fever, sympathetic hyperactivity, confusion or convulsion, MDMA poisoning should be considered.

Objective To update our epidemiological knowledge of acute poisoning in Hong Kong. Methods A multi-centred prospective study was conducted for six months in six major accident and emergency departments in Hong Kong. A specially designed form was used to collect demographic data, type of poison involved, cause of poisoning, management, disposal as well as final outcome of the poisoned patients. Results A total of 1,467 patients (male: 588, female: 879) were included in the study. Most of them were young adults (32% were between 20 and 40 years old). Suicidal attempt (64%) was the most common cause of poisoning. Notably, 379 (26%) patients took more than one poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and analgesics (18%) were the most commonly used drugs and paracetamol was the commonest single ingredient involved in poisoning. Most patients were treated with supportive measures, and about 40% and 15% of the patients were given gastrointestinal decontamination and specific antidotes respectively in their management, in which activated charcoal and N-acetylcysteine were the most common. Concerning disposal from the emergency department, 91% of the poisoned cases required in-patient management. Most patients had an uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%) died. Suicidal carbon monoxide poisoning was the leading cause of mortality in our study. Conclusions Most acute poisonings in Hong Kong were suicidal in nature and paracetamol was the commonest agent. Activated charcoal was the most commonly used decontamination method and most patients had an uneventful recovery.

A healthy 28-year-old man presented with multiple brief episodes of convulsion. He was found to have ventricular fibrillation which required defibrillation in the emergency department. After exclusion of organic heart diseases, Brugada syndrome was diagnosed and required implantable cardioverter defibrillator (ICD) implantation. The case emphasized the recognition of malignant cardiac dysrrhythmias as a cause for seizures. The management in the emergency department was discussed. (Hong Kong j.emerg.med. 2002;9:105-109)

Fructus Psoraleae (FP) is used by herbalists for the treatment of postmenopausal osteoporosis, vitiligo, and psoriasis. It is used alone, or in combination with other herbs, in some countries in the form of proprietary medicine. It is recognized as one of the emerging hepatotoxins and here we report three cases of acute hepatitis after exposed to FP and its related proprietary medicine. It seems possible that psoralen and its related chemicals may be responsible for the hepatotoxicity. Decoction with other herbs may result in higher concentration of toxic constituents and in more severe liver injury. In summary, FP is associated with hepatotoxicity in some individuals. Pharmacovigilance for the potential side effects of herbal products is necessary.

Introduction Traditional Chinese Medicine (TCM) use has been believed to be common in Hong Kong but no data existed on its prevalence among emergency patients. We conducted a prospective survey to study the prevalence of its use, the type of TCM use, frequency and nature of associated adverse reactions. Methods All accident & emergency department (AED) attendances at the United Christian Hospital were screened by the triage nurse and attending doctor for TCM use and its type in a consecutive 31 day period. The causal relationships between the TCM and their presenting illness were also assessed and decided by the doctor in-charge. Results 291 out of 21,475 patients (1.4%) reported TCM use within one week. Among them, 117 (40.2%) consumed Chinese herbal medicine, 75 (25.8%) took proprietary Chinese medicine, 1 (0.3%) took both, 96 (33.0%) received topical treatment and 2 (0.7%) were unclassified, with 22 out of the 291 TCM users (7.6%) presented for TCM-related toxicity. Most complications were mild, the commonest ones being dermatitis after topical treatment (68.2%) and allergic reaction after oral intake (22.7%). Conclusion A small number of patients took TCM treatment shortly before AED consultation. Most TCM-related toxicities were mild and the commonest reactions were dermatitis and systemic allergy.

Pseudo-subarachnoid hemorrhage (PSAH) is a false-positive finding on cranial computed tomography (CT) in patients with cerebral edema. Its appearance on CT resembles subarachnoid hemorrhage despite the absence of subarachnoid blood. We report the finding of PSAH in a case of massive valproic acid overdose.

To evaluate an algorithmic approach involving a multidisciplinary team for causality assessment of suspected herb-induced liver injury (HILI) cases and to compare the causality score using this multidisciplinary approach and Roussel Uclaf Causality Assessment Method (RUCAM).A team consisting of hepatologist, clinical toxicologist, analytical toxicologist, and Chinese medicine (CM) pharmacist was formed to do causality assessment based on a protocol for suspected HILI cases. The likelihood of the diagnosis of individual case was first assessed systematically by a hepatologist and clinical toxicologist independently after collecting information about four aspects: (1) clinical course, (2) exclusion of alternative causes, (3) quality of the prescription and herbal product by examining the CM prescriptions and analysis of biological and herb samples, (4) scientific support on comprehensive literature review on English and Chinese medical database, and subsequently concluded in a consensus meeting held by the multidisciplinary team. The final causality score of each patient was compared with the likelihood of causality as assessed by RUCAM.Between 2005 and 2007, 48 consecutive patients with suspected HILI were enrolled and 21 patients were excluded due to the establishment of an alternative cause of liver impairment or the lack of any information on the herbs taken. Twenty-seven patients were recruited, among them 15 consumed Chinese herbal medicines, 10 used proprietary Chinese medicinal products, and 2 used both. The concordance between the causality assessment of the hepatologist and clinical toxicologist was moderate (weighted κ = 0.48, 95%CI 0.30-0.66). The causality assessment process concluded that the likelihood of HILI was "highly probable" in 5 cases and "probable" in 12, whereas there were 5 "highly probable" and 16 "probable" cases as assessed by RUCAM. The causality assessment by the multidisciplinary approach and RUCAM also showed moderate agreement (weighted κ= 0.51, 95%CI 0.22-0.81).A multidisciplinary approach using defined algorithms is a scientific approach in causality assessment for HILI. Further study is needed to assess its accuracy and applicability.

Nonradioactive cesium chloride (CsCl) is used by some alternative medicine advocates as a treatment for cancer. The therapy was proven to be neither safe nor effective. Chronic use of CsCl has resulted in cases with severe cardiotoxicity.A 65-year-old lady presented to our hospital's accident and emergency department with recurrent syncope attacks. Electrocardiogram monitoring showed QT prolongation and transient Torsades de Pointes (TDP) ventricular tachycardia. She was taking anticancer naturopathic drugs for 6 weeks before admission. One of her naturopathic drugs was subsequently confirmed containing 89% CsCl by weight. Besides conventional treatment of QT prolongation and TDP, the patient was given a 4-week course of oral Prussian blue to enhance gastrointestinal elimination of cesium. The serum half-life of cesium was reduced from 61.7 to 29.4 days after the use of Prussian blue. QT prolongation was normalized in 27 days.To our knowledge, this is the first published case of nonradioactive cesium poisoning treated with Prussian blue. A transient rise in serum cesium level was observed during Prussian blue therapy. Possible explanations for this observation include poor drug compliance during outpatient treatment and redistribution of cesium from body stores.Nonradioactive CsCl poisoning can result in severe cardiotoxicity with QT prolongation and TDP ventricular tachycardia. The key points in the management of nonradioactive cesium poisoning include cessation of cesium exposure, vigorous electrolytes replacement, and oral Prussian blue therapy.

Fish gallbladder has long been used as folk remedy in China. Poisoning due to carp gallbladder ingestion has been reported in many countries but the majority of cases are in Chinese journals. We report a case of grass carp gallbladder poisoning and review the literature, including the Chinese reports.A 67 year old woman ingested a grass carp gallbladder and complained of nausea and epigastric pain in two hours, and had elevated alanine aminotransferase by 8 hours. She developed oliguria on day three and hemodialysis was performed on day five, following which she gradually recovered and was discharged on day 26.Carp gallbladder contains 5 alpha-cyprinol sulphate, which is hepatotoxic and nephrotoxic. The exact mechanism of toxicity is unknown. Mild poisoning causes only gastroenteritis, liver and kidneys are affected in moderate poisoning, and multi-organ failure occurs in severe poisoning. The initial symptoms are nausea, vomiting, diarrhea and abdominal pain, which usually occur 5 to 12 hours after ingestion. Raised liver enzymes or jaundice occurs in 75% to 87% of patients. Acute renal impairment occurs in 72% to 87% of patients, usually on day 3 to 6. Treatment is supportive and often included hemodialysis.The ingestion of grass carp gallbladder may result in transient hepatitis with subsequent acute renal failure. This case also illustrated the importance of understanding the use and potential serious complications of alternative medicines. Fish gallbladder poisoning should be considered in unexplained acute renal failure in Chinese and Asian patients.

Objective To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion, peak oxygen uptake, peak power, and self-reported physical function in children with juvenile idiopathic arthritis (JIA). Methods Eighty children with JIA, ages 8–16 years, were enrolled in a randomized, single-blind controlled trial. Both groups participated in a 12-week, 3-times–weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group. Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour (VO2submax) as the primary outcome, maximal oxygen uptake, and peak power at the beginning and end of the program. Physical function was measured using the Child Health Assessment Questionnaire (C-HAQ). Results The exercise program was well tolerated in both groups. There was no difference in VO2submax or any other exercise testing measures between the groups through the study period and no indication of improvement. Both groups showed significant improvements in C-HAQ with no difference between the groups. Adherence was higher in the control group than the experimental group. Conclusion Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function. The intensity of aerobic training did not seem to provide any additional benefits, but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with, and provide a degree of benefit equivalent to more intensive programs.

Objectives: To determine if a shorter interval between Kawasaki disease (KD) treatment with intravenous immunoglobulin (IVIG) and fever onset results in increased treatment failures, need for adjunctive therapy, or development of coronary artery lesions. Study design: Patients with KD (n = 178; 89 matched pairs) diagnosed between 1987 and 1999 were included in this case-control study. All patients had fever plus at least 4 of the 5 clinical criteria for KD. Eighty-nine patients who received IVIG at day 5 or earlier were matched to patients diagnosed within 4 weeks and given IVIG at days 6 to 9 of fever. Compiled data from a detailed chart review included demographics, clinical features, fever duration, investigations, disease course, and response to therapy. Differences between matched case and control pairs were analyzed by means oft tests and McNemar tests. Results: No demographic differences were noted between the two groups. Patients treated on day 5 or less of fever had a shorter total fever duration (5.2 ± 1.9 days vs 8.0 ± 1.8 days, P

Ruttonjee Hospital, Accident and Emergency Department, 266 Queen’s Road East, Wanchai, Hong Kong Sia Yin Shan, Jacky, FHKCEM, FHKAM(Emergency Medicine) An 87-year-old man with hypertension, ischaemic heart disease and heart failure, on long term drug therapy including enalapril, attended our emergency department 12 hours after an intentional overdose of 15 g of paracetamol. N-acetylcysteine (NAC) intravenous infusion was started empirically with the initial loading dose of 150 mg/kg in 15 minutes. The paracetamol level was later confirmed to be above the treatment line in the nomogram.