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Introduction: The Hong Kong Poison Information Centre (HKPIC) has been providing consultation services to healthcare professionals and collecting epidemiological data on poisoning in Hong Kong since 2005. Objective: To analyse and report the poisoning data from HKPIC in 2021. Methods: A retrospective review was conducted on all poisoning cases recorded in the Poison Information and Clinical Management System of HKPIC in 2021. Results: A total of 3973 poisoning cases were analysed. There was an increase of approximately 10% in total poisoning cases compared to 2020, bringing the total caseload back to the pre‐COVID era. Teenage (13–19 years) poisoning incidence continued to rise, reaching a recorded high of 16.2% of total poisoning cases. Notably, poisoning cases involving selective serotonin receptor inhibitors showed a significant increase, along with the use of the antidote cyproheptadine. The majority of these cases involved individuals under the age of 20 presenting with suspected self‐harm. Compared to 2020, the number of poisoning‐related deaths decreased by 25%, from 48 to 36 deaths in 2021, resulting in a case fatality rate of 1.0%. Additionally, six interesting cases and two poisoning clusters were discussed. Conclusions: The 16th annual report provides valuable information on poisoning patterns in Hong Kong during the second year of the COVID‐19 pandemic, highlighting significant changes compared to previous reports. [ABSTRACT FROM AUTHOR]

Aims: Lacosamide is a third‐generation antiepileptic drug used as adjunctive therapy for partial seizures. Since its approval in 2008 very few cases of lacosamide overdose have been described in literature. The aim of our study was to evaluate clinical characteristics of acute lacosamide poisoning. Methods: A retrospective observational study was performed including all cases of acute lacosamide poisoning referred to Pavia Poison Control Centre from January 2012 to December 2021. For each patient age, sex, ingested dose, coingestants, clinical manifestations, treatment and outcome were collected. Results: A total of 31 subjects (median age 39 years, [interquartile range: 26.5–46.5]; females 22/31) were included. The median lacosamide ingested dose was 1500 mg [650–2800]. In 35.5% of cases lacosamide was the single ingested substance, while in 64.5% coingestants were also present. Coingestants varied from a minimum of 1 to a maximum of 3, with the more common being benzodiazepines and valproic acid. Clinical manifestations were present in 87% patients the most common were: vomiting (29%); seizures (29%), coma (25.8%), drowsiness (25.8%), confusion (12.9%), agitation (12.9%), tachycardia (12.9%), tremors (9.7%), bradycardia (9.7%), headache (6.5%) and hypertension (3.2%). The median lacosamide ingested dose was significantly higher in patients that experienced coma compared to patient who did not (2800 vs. 800 mg; P =.0082). Orotracheal intubation was necessary in 32.3% of patients. All patients fully recovered. Conclusion: Lacosamide acute overdose may lead to a severe clinical picture. Dentral nervous system symptoms predominated, particularly seizures and coma occurred in a high percentage of cases. [ABSTRACT FROM AUTHOR]

Background: The Hong Kong Poison Information Centre has provided consultation service to healthcare professionals and collected epidemiological data on poisoning in Hong Kong since 2005. Objective: To analyse and report the poisoning data of Hong Kong Poison Information Centre in 2020 during the COVID-19 pandemic. Methods: A retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2020. Results: A total of 3633 poisoning cases were analysed. Compared to 2019 (pre-COVID era), there was a reduction of ~10% of total poisoning cases recorded (383 cases), with a majority (> 90%) of reduction from poisoning cases with no clinical effect (353 cases). A greater proportion of reduction was observed among the children (0–12 years), patients with general unintentional poisoning, poisoning due to therapeutic error and food poisoning. An increased number of cases was noted from abusive use, adverse herb/proprietary Chinese medicine reaction and poisoning related to household bleaches. Teenage (13–19 years) poisoning seemed to be unaffected by the COVID-19 pandemic and the previously observed increasing trend continued (up to 11.8% of total poisoning cases this year). Despite a total reduction in poisoning cases recorded, the number of deaths increased by 37% from 35 in 2019 to 48 in 2020 (mortality rate 1.5%). A total of seven interesting cases were discussed. Conclusion: This 15th annual report provides updated epidemiological information on poisoning patterns in Hong Kong during the COVID-19 pandemic. It also highlighted important changes and possible effects of the COVID-19 pandemic on poisoning in Hong Kong in comparison with our previous reports. [ABSTRACT FROM AUTHOR]

This study describes the exposures and suspected intoxications in children (0–14 years) managed by an Italian reference poison control center (PCC). A seven-year observational retrospective study was performed on the medical records of the Toxicology Unit and PCC, Careggi University Hospital, Florence (Italy). During the study period (2015–2021), a total of 27,212 phone call consultations were managed by the PCC, of which 11,996 (44%) involved subjects aged 0–14 years. Most cases occurred in males (54%) aged 1–5 years (73.8%), mainly at home (97.4%), and with an oral route of intoxication (93%). Cases mainly occurred involuntarily. Consultations were generally requested by caregivers; however, in the age group 12–14 years, 70% were requested by healthcare professionals due to voluntary intoxications. Cleaners (19.44%) and household products (10.90%) were the most represented suspected agents. Pharmacological agents accounted for 28.80% of exposures. Covariates associated with a higher risk of emergency department visit or hospitalization were voluntary intoxication (OR 29.18 [11.76–72.38]), inhalation route (OR 1.87 [1.09–3.23]), and pharmacological agents (OR 1.34 [1.23–1.46]), particularly central nervous system medications. Overall, consultations do not burden national and regional healthcare facilities, revealing the activity of PCCs as having a strategic role in reducing public health spending, even during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

For poisoned patients, ambulance services may be the first point of contact for medical attention. With limited training in toxicology, ambulance services are encouraged to contact the Poisons Information Centre (PIC) for advice. This study aims to characterise referrals to a PIC from a state ambulance service with the purpose of improving information delivery and efficient use of these services. This was a retrospective observational series of referrals to an Australian state PIC from ambulance staff from 1 January 2020 to 31 December 2020. Referrals were identified through the PIC Pharmhos database where the call originated from either a paramedic or emergency dispatch officer. Call reports were reviewed to extract data on patient demographics, exposure details and advice provided by the PIC. There were 1537 calls regarding 1420 poisoning exposures over the 12-month period, with 117 (7.6%) follow-up calls, representing 4.1% (1537/37835) of total calls to the PIC. Initial calls originated from paramedics in 999/1420 (70.4%) referrals, with dispatch officers referring 421/1420 (29.6%). Paediatric patients aged <15 years were involved in 492/1420 (34.6%) exposures with the commonest age range being 1–4 years. Most referrals involved pharmaceuticals exposures (756/1420 [53.2%]) followed by chemicals (557/1420 [39.2%]) and drugs of abuse (69/1420 [4.9%]). The commonest agents involved were paracetamol followed by quetiapine and sertraline. The PIC advised no treatment following benign exposures in 617/1420 (43.5%) calls, first aid measures in 333/1420 (23.5%) calls, supportive measures in 339/1420 (23.9%) calls and specific treatment in 32/1420 (2.3%) calls. Referral to the hospital was advised in 761/1420 (53.6%) calls, the majority of these were following deliberate self-poisonings (428/1420 [30.1%]). Ambulance staff commonly contact the PIC following benign exposures where no treatment is required. Ambulance referral to a PIC following suspected poisonings may have a role in preventing unnecessary transfer to hospital in poisoned patients. [ABSTRACT FROM AUTHOR]

Abstract Introduction Acute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry. Methods This study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group “P”), or who presented to the Emergency Department (group “ED”), during the three-year period 2014–2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for “P”, and hospital admission for “ED”group). Results We collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission. Conclusions Our study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic.

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. [ABSTRACT FROM AUTHOR]

In June 2019, a paralytic shellfish poisoning (PSP) case related to the consumption of mussels contaminated by saxitoxins at a concentration below the regulatory threshold came to the attention of the French Agency for Food, Environmental and Occupational Health and Safety (ANSES). This pointed to probable undetected human cases of poisoning by neurotoxic phycotoxins. We conducted a retrospective study of poisoning cases by bivalve shellfish (oysters, mussels and scallops) recorded by the French Poison Control Centres (PCC) from 2012 to 2019. All medical records were reviewed by a toxicologist. Cases that could be related to neurotoxic phycotoxins were selected and described. Diagnosis was based on symptoms compatible with ingestion of contaminated shellfish and on contamination data for the shellfish production area (analysed by the French Research Institute for Exploitation of the Sea, Ifremer), or notifications to the European Rapid Alert System for Food and Feed when the origin of the shellfish was known. Among the 619 shellfish poisoning cases recorded by the PCCs from 2012 to 2019, 22% (n = 134) had reported at least one neurological symptom (headache, dizziness or paraesthesia). Review of medical records for the 134 patients led to suspicion of 14 cases of PSP and one case of amnesic shellfish poisoning. Five patients experienced persistent neurological symptoms. Marine toxins were not tested for in the blood or urine of these patients. This retrospective identification of cases strongly suspected of being related to neurotoxic phycotoxins led ANSES, PCCs and Ifremer to develop a specific questionnaire and to recommend actions to take when neurological symptoms related to shellfish consumption are reported to a PCC. Daily monitoring of shellfish poisoning cases registered in the national PCCs database was also implemented in order to rapidly detect any suspicious cases, alert the competent authorities, and warn the general population. [ABSTRACT FROM AUTHOR]

Data on cleaner and disinfectant exposure and misuse-related acute intoxications in Italy during SARS-CoV-2 pandemic are still lacking. The aim of the present study was to analyse and describe cleaner and disinfectant-related intoxications during SARS-CoV-2 pandemic in an Italian poison control centre. Data were obtained from the toxicological consultations requested to the Toxicology Unit and Poison Centre, Careggi University Hospital, Florence (Italy). We compared data from January 1st to April 30th of 2019 and 2020. Data concerning probable or acute intoxication from any causative agent in the general population (all age groups), from private individuals or from Regional and National health structures, were included in the analysis. A toxicological evaluation was also performed to calculate the Poisoning Severity Score. In 2019, 451 phone counselling sessions were performed and compared to a total of 410 calls received during the same period of 2020. In both periods, the majority of events occurred in paediatric (0–17 years) and adult (18–65 years) patients, who were mainly exposed to one toxic agent, and intoxications took place principally at home due to domestic accidents. The oral route of intoxication was the most frequently observed one, followed by inhalation of toxic agents, which increased by 4.7% in 2020. In 2020, sanitizers and cleaners were reported in 21.6% of cases compared to 12.5% in 2019. This is the first study describing cleaner and disinfectant-related intoxications in Italy. Our results suggested a possible misuse of these products during the SARS-CoV-2 pandemic, underling the effects of home isolation on mental health and unintentional toxic exposures. [ABSTRACT FROM AUTHOR]

The transfer of a chemical product from its original container to an unlabelled secondary container by consumers is a potential health hazard that may result in unintentional exposures and intoxications. The aim of this study was to describe the pattern of prevalence of exposures to transferred products in Italy from year 2017, when the new European labelling regulation for chemicals became fully operative, to 2020, year of the coronavirus 19 disease first outbreak. Calls to the Poison Control Centre (PCC) of Policlinico Umberto I Hospital ‐ Sapienza University of Rome were analysed retrospectively for characteristics, clinical presentation and circumstances related to the event. We registered 198 cases of interest. There was a reduction in cases from 2017 (4.9%) to 2019 (2.2%), followed by an increased prevalence in 2020 (4.2%) mainly due to the months "post‐lockdown." The transferred product was very frequently diluted, and an empty drinking bottle was usually used as secondary container. Exposures were mostly of minor severity, and no deaths occurred. The study highlights the importance of PCCs data in the evaluation of the hazard communication to users through labels and advises for public campaigns to promote safe behaviours during future lockdowns to prevent exposures at a later period. [ABSTRACT FROM AUTHOR]

Background: Iatrogenic medication errors are a cause of medical morbidity and mortality. They result in significant cost to the Australian healthcare system each year. There is limited Australian evidence describing the iatrogenic errors occurring within the hospital system. Aims: To examine and describe iatrogenic medication errors occurring in Victorian healthcare settings through the analysis of referrals to a state Poisons Information Centre (PIC). Methods: A retrospective review of iatrogenic medication errors reported to the Victorian PIC (VPIC) from community and hospital healthcare settings from January 2015 to December 2019. Results: Over a 5-year period, 357 iatrogenic errors were identified, 63% (n = 224) of which occurred in a hospital setting. The remaining errors occurred in a community healthcare setting. One in five patients were symptomatic from the medication error at the time of the call to the VPIC, and a change in management was required in 45% (n = 165) of all cases. Five percent (n = 17) of patients developed moderate to severe clinical toxicity as determined by the recorded poisoning severity score, and 88% (n = 18) of these required critical care management. Incorrect medication dosing accounted for 62% (n = 221) of errors. Common medication dosing errors included: double dose (51%, n = 114), incorrect medication administered (14%, n = 49), incorrect route (9%, n = 31), incorrect patient (6%, n = 22) and adult dose given to a child (4%, n = 15). Conclusions: Iatrogenic errors are occurring in the Victorian health care system. These errors can result in serious morbidity. Identification of causative factors and investment in preventative strategies will likely reduce associated morbidity and healthcare costs. [ABSTRACT FROM AUTHOR]

Poisoning is a major global health concern. Every year, unintentional poisoning contributes to 106,683 deaths globally. In Kuwait, paediatric poisoning cases comprise approximately 50% of total poisoning cases. Despite the extensive importance and the long history of poison control centres (PCCs) and the emphasis of the World Health Organization (WHO) to establish a PCC in Kuwait, no functional PCC exists in Kuwait. Here we reported 82 poisoning cases between July and December 2020, revealing a 100% increase in comparison to the official figures published in 2004 and 2005. No fatalities were reported, and all cases were discharged home within 12 h of their visit to the casualty. Children aged 2 to < 4 years comprised the most reported poisoning cases with approximately 45% of the total. The number of male child poisoning cases was approximately two-fold of female children. The most common poisoning agent was silica gel granules (9%) followed by medicines – reported as paracetamol (7%), diclofenac (7%), multivitamin gummies (7%) and vitamin C (5%). Among other causes of poisoning were ingestion of salbutamol nebulizer solution (4%), oral contraceptives and insecticides (4%). These findings reveal the importance of establishing a functional PCC in Kuwait to minimise the unnecessary visits following ingestion of expired orange juice and henna, that may encounter further contraction of infections, especially with the current state of the COVID-19 pandemic. Moreover, a functional PCC would provide comprehensive data and hence further intervention such as shifting the dosage form of salbutamol from nebulizer solution to metered dose inhaler with a spacer, in addition to increasing public awareness towards minimizing such a dramatic increase in casualty visits because of -suspected poisoning. [ABSTRACT FROM AUTHOR]

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., Tityus obscurus, Tityus sylvestris and Centruroides pococki, in French territories are limited to French Guiana and Lesser Antilles. Class II envenoming cases are recorded for Buthus occitanus, Euscorpius spp. in mainland France, and Isometrus maculatus in French Guiana, the Lesser Antilles (Guadeloupe and Martinique) and territories in the Indian Ocean (Mayotte and Réunion Island) and Pacific Ocean (French Polynesia). Only cases of local manifestation was reported for Belisarius xambeui in mainland France. Scorpion stings in French territories are frequently on the Mediterranean coast and French Guiana. Life-threatening cases are limited to T. obscurus, T. sylvestris and Centruroides pococki stings in French Guiana and Lesser Antilles. [ABSTRACT FROM AUTHOR]

Introduction: Acute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry. Methods: This study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group "P"), or who presented to the Emergency Department (group "ED"), during the three-year period 2014–2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for "P", and hospital admission for "ED"group). Results: We collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission. Conclusions: Our study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic. [ABSTRACT FROM AUTHOR]

Aims: To study the predictive factors for the development of clinical manifestations in poisoning due to the erroneous taking of low‐dose methotrexate (MTX). Methods: A retrospective observational study was performed. Only cases of erroneous administration in non‐oncologic outpatients were included (July 2008‐March 2020). Results: Forty‐one cases were included. All patients were taking MTX for the first time. In 36 cases, patients took MTX daily instead of weekly. In the other five patients, MTX was sold instead of methylergometrine. Clinical manifestations were absent in 12/41 patients (29.3%). All 29 (70.7%) symptomatic patients recognized the medication error when they developed clinical manifestations: dermatological, haematological and gastrointestinal symptoms. Statistical results showed that symptomatic patients were older, received a higher amount of total dose and were treated for longer. Moreover, the probability of being symptomatic increases as a function of age and of total dose. Asymptomatic patients were treated with folinic acid (30 mg/m2/day) for 5 days. Symptomatic patients were treated with folinic acid together with treatments for the specific clinical manifestations. No patients were treated with glucarpidase. All patients fully recovered. Conclusions: When MTX is prescribed for the first time, it is important to clearly communicate with patients to avoid therapeutic errors. In our experience, age, total dose taken and number of days of assumption are predictive for the presence/absence of clinical manifestations. These parameters must be evaluated together to identify patients needing maximum starting treatment with folinic acid and closer monitoring. [ABSTRACT FROM AUTHOR]

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. Retrospective, descriptive study of CFP cases handled by the French Poison Control Centre Network from 2012 through 2019. 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). 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. [ABSTRACT FROM AUTHOR]

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 (<0.1%). The majority of cases (68.3%) were between 20 and 69 years old, and 9.9% involved children of 0–5 years old. The common causes of poisoning were suspected self-harm/suicidal attempt (36.6%), unintentional exposure (18.4%) and abusive substance use (11.1%). Excluding the common co-ingestant ethanol, the five commonest types of poison were benzodiazepines, paracetamol, Chinese herbal medicine, household products and zopiclone. Most patients were managed with supportive measures, while 13.5% and 13.7% of consultation cases were treated by decontamination and antidotes, respectively. The majority of cases had uneventful recovery; 0.8% resulted in death and 4.9% had major outcomes. A total of eight interesting cases were discussed. 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. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin is still considered the "gold standard" and is, therefore, increasingly prescribed. Monitoring of metformin continues to be debated because of its association with lactic acidosis (MALA), a rare but life‐threatening complication. The aim of this study was to identify the main individual characteristics associated with severe poisoning in self‐poisonings and therapeutic accidents reported at the Western France Poison Control Centre (PCC). Methods: Retrospective study of metformin poisoning from September 1999 to September 2016 at the Western France PCC recorded in the French PCC's database (SICAP). The end‐point was clinically high severity (mortality and/or cardiovascular shock and/or GCS ≤ 7/15). Results: Of the 382 cases included, 197 concerned acute accidental exposures, 127 self‐poisonings and 58 therapeutic accidents. MALA concerned 63 patients: 44 therapeutic accidents and 19 self‐poisonings. High severity concerned 59 patients: 47 therapeutic accidents and 12 self‐poisonings. T2D and age > 60 significantly increase the risk of high severity (OR 7.7, CI [1.54‐38.41]; P = 0.013; OR 3.5, CI [1.60‐7.84]; P = 0.002, respectively). Conclusions: Metformin may lead to MALA and severe poisoning in therapeutic accidents but also in self‐poisoning circumstances. Among reported cases, T2D history and age >60 increase the risk of serious poisoning. Monitoring of their treatment should be taken seriously especially in the event of digestive symptoms such as diarrhoea. [ABSTRACT FROM AUTHOR]

The use of extracorporeal treatments (ECTRs) for poisonings with four non‐traditionally dialysed toxins (NTDTs) is increasing in the United States. This study evaluated whether ECTRs are prescribed for toxin removal or the treatment of other medical illnesses or complications. We performed a 2‐Phase retrospective analysis evaluating the main indication for ECTRs in patients with poisoning from a NTDT (defined for this study as acetaminophen, opioids, tricyclic antidepressants (TCAs) or digoxin) and ECTR. The first phase assessed all cases from a single site (New York City Poison Control Center) between the years 2000 and 2016, and the second phase surveyed all United States Poison Control Centers (PCCs). In Phase 1, demographics, toxin ingested and main indication for ECTR were extracted. In Phase 2, a query to the National Poison Data System using the a pragmatic subset of inclusion criteria from Phase 1 restricted to single toxin ingestions over a narrower time frame (2014‐2016) provided the cases for study. A structured online questionnaire was sent to all United States PCCs to request their database review regarding the indication for ECTR for their cases. In Phase 1, 92 cases met inclusion criteria. In Phase 2, 519 cases were screened and 425 met inclusion criteria. In Phase 1 91/92 (98.9%) and Phase 2 411/425 (96.7%), of extracorporeal treatments were used to treat underlying medical conditions or poisoning‐related complications rather than accelerate toxin removal. The increasing number of ECTRs reported in patients who ingested one of the four NTDTs thus appears to be for medical indications rather than attempts at toxin removal, a distinction that is important. [ABSTRACT FROM AUTHOR]

Background:Ingestion of elemental mercury (Hg0) is considered non-toxic. After massive ingestion, local intestinal complications may develop: retention within appendix is quite frequent but treatment is debated. We describe a case of intentional ingestion of Hg0 requiring multi-step decontamination and prophylactic appendectomy. Case detail:A 19-year-old woman was admitted to ED for abdominal pain. History revealed ingestion of large amount of Hg0 as suicide attempt. To prevent absorption, facilitate elimination, and avoid complications a conservative approach was started. Due to inefficacy of initial maneuvers colonoscopy with irrigation/aspiration was performed, repeated whole bowel irrigation was continued and second colonoscopy was performed to clean residual metal. Abdominal plain films confirmed the presence of retained mercury within the appendix in asymptomatic patient. To reduce risk of appendicitis, potential perforation, and possibly systemic toxicity, a prophylactic laparoscopic appendectomy was performed at day 5 with removal of all retained mercury without peritoneal spillage. Highest mercury concentration was 22.7 mcg/L in serum (1-4.5 mcg/L) and 5.1 mcg/L in urine (0.1–5 mcg/L). Conclusions:After ingestion, metal retention in appendix is quite frequent. Evidence about optimal treatment are different and based on case reports. A multi-step approach with multidisciplinary evaluation tailored to the patient is suggested. [ABSTRACT FROM PUBLISHER]

Background: Poison Control Centre of Morocco (MPCC) plays a key role in promoting health. This study was aimed to demonstrate the role of the MPCC in improving public health and poisoning management. Methods: This was a retrospective study of poisoning cases reported to the MPCC between 1980 and 2011. The collected data included number of poisoning cases, profession of interlocutor who called the poison centre, time of poisoning (year), gender of poisoned patient, age of poisoned patient, toxic agent and intention of poisoning. Data were analyzed using Epi Info software. The activities of MPCC were evaluated by three indicators including structural indicators, process indicators and impact indicators Results: Between 1980 and 2011, the MPCC received 401148 notifications which 73.1% of them involved scorpion stings and 26.9% were about other toxic agents. The main causes of poisoning, excluding scorpion stings, were pharmaceuticals (6.1%) followed by food (5.9%) and carbon monoxide (4.5%) poisoning. The MPCC devised five protocols through a consensual method and distributed to practitioners in hospitals around the country considering gastric emptying, management of PPD poisoning, management of scorpion stings, management of carbon monoxide poisoning and the management of snakebite. Gastric emptying decreased from 45% to 4% of cases during this period. A national strategy was set up for the management of scorpion stings leading to a decrease in mortality from 1.54% to 0.22%. Conclusion: During the period of more than two decades, the achievements of the MPCC have not been limited to providing toxicological information, but also activating a proper toxicovigilance system. In fact, a poison control centre is not a luxury structure. It is an integral part of every health system. Its impact on reducing morbidity and mortality is no longer discussed and its observatory role on poisonings should be strengthened. How to cite this article: Rhalem N, Aghandous R, Chaoui H, Eloufir R, Badrane N, Windy M, et al. Role of the Poison Control Centre of Morocco in the Improvement of Public Health. Asia Pac J Med Toxicol 2013;2:82-6.

Context:Oxetorone is a serotonin antagonist antimigraine drug but literature relating to its toxic properties is poor. The aim of this study is to describe the toxicological profile of oxetorone and to highlight any relationship between clinical and analytical findings. Materials and methods:This is a retrospective and observational study of cases exposure to oxetorone, reported to the Angers Poison and Toxicovigilance Centre between January 2002 and May 2016. Severity was assessed using the Poisoning Severity Score (PSS). Cases where data were incomplete, where oxetorone was deemed not accountable, where clinical signs were linked mainly to a co-ingested drug or where the plasma concentration of oxetorone was negative were all excluded. Results:We included 43 cases of exposure, 31 of whom were suicide attempts. The assumed ingested dose (60–3600 mg) was correlated to severity (rs = 0.45,p = 0.01). Symptoms of moderate severity (PSS2 = drowsiness, hypertonia, myosis, convulsions, arterial hypotension, QRS widening, QTc prolongation) were observed following ingestion of more than 600 mg of oxetorone (median dose =1200 mg) and severe symptoms (PSS 3 = coma, convulsions, QTc prolongation, QRS widening, ventricular tachycardia, arterial hypotension, cardiogenic shock) were observed starting from 1800 mg (median dose =2700 mg). In four cases, a secondary worsening of symptoms 10–48 h following ingestion was observed. Plasma oxetorone was measured in four patients. Severe symptoms were observed in the event of a concentration over 0.3 mg/L and the highest measured serum oxetorone level was delayed by 20–48 h following the ingestion for two cases. Conclusions:Several clinical and paraclinical parameters strongly point towards membrane-stabilising properties of the molecule and the risk of a delayed occurrence of symptoms or a secondary worsening. [ABSTRACT FROM PUBLISHER]

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A retrospective study of telephone calls concerning poisoning due to pharmaceutical products, attended by the Toxicological Information Service in Seville (Spain), is presented. The years 1993 and 1994 were analized. Demographic data including the age and sex of the patient, route of exposure, cause, type of poisoning and the therapeutic group, was obtained. The great majority were cases of acute poisoning due to domestic accident, attempted suicide took second place. Ingestion was the principal route of entry, and more males than females were affected. 35.2% were children under two. In general, the medicines most frequently involved were those affecting the nervous system (28.1%) – principally analgesics, anxiolytics and antidepressants – followed by dermatological agents (13.7%) – such as antiseptics and disinfectants – and those affecting the respiratory (medicines to treat common cold, bronchodilators, antitussives) and digestive systems (laxatives, antiacids). It is hoped that with knowledge of data from as many poisons centres as possible, an improvement may gradually be seen in the prevention of the such poisoning in the future. [ABSTRACT FROM AUTHOR]

The article examines caveats in interpreting poison control centre (PCC) data in spider bite epidemiology studies. It highlights some cautionary reasons why PCC databases are not completely reliable. It offers an overview of a study using PCC data which demonstrated the overdiagnoses of brown recluse spider bites in Florida.

Objectives: Toxicodynetics aims at defining the time-course of major clinical events in drug overdose. We report the toxicodynetics in mono-intoxications with oxazepam and nordiazepam., Methods: Cases of oxazepam or nordiazepam overdoses collected at the Paris poison control centre from 1999 to 2014 on the basis of self-report. A particular attention was paid to eliminate the concomitant alcohol or psychotropic co-ingestions. The toxicodynetic parameters were assessed as previously described. Results are expressed using 10-90 percentiles. In adults, the dose was normalized (TI, toxic Index) by dividing the supposed ingested dose by the maximal recommended dose., Results: Two hundred and fifty-one and 74 cases of oxazepam and nordiazepam poisonings were included, respectively. The Emax for oxazepam and nordiazepam were sleepiness or obtundation in 106 and 36 cases, respectively. Coma was used to qualify only one oxazepam overdose. The median delay in onset of the Emax was 1.5h (0.33-15) in nordiazepam and 4h (0.5-15) in oxazepam overdose. In both overdoses, the onset of Emax occurred on an "on-off" mode. In adults, the greatest TIs in nordiazepam and oxazepam overdoses were 45 and 26.7, respectively. The TI in the oxazepam-induced coma was 26.7, the largest dose., Conclusion: Data collected in PCC allow determining a number of toxicodynetic parameters. Toxicodynetics showed that nordiazepam is not a cause of coma even in large overdose while oxazepam causes coma only at a very high dose. Deep coma in nordiazepam overdose whatever the dose and deep coma in overdose with oxazepam involving TI less than 20 result from unrecognized drug-drug interaction., (Copyright © 2017. Published by Elsevier Masson SAS.)