Journal of Drug Metabolism & Toxicology
Open Access

Evaluation of the Toxicologic Cases in Emergency Service

Neslihan Gürbüz^{* *}Correspondence: Dr. Neslihan Gürbüz, Department of Emergency Medicine, Gazi University Hospital Adult Emergency Service, Beşevler,Ankara, Turkey, Email:

Author info »

Description

Poisonings is an important public health problem that constitutes an important part of emergency service applications and can lead to serious health consequences [1,2]. Toxicological cases admitted to the emergency department include suicide, chemical substances poisoning, CO poisoning, food poisoning, alcohol poisoning, substance intake and etc. are situations.

Poisoning events in general; prescription or over-the-counter use occurs due to patient-initiated medication iatrogenic administration of high-dose drugs, accidental exposure to chemicals or deliberate ingestion of biological agents for suicide. Medicinal drugs are the most common (47%-86%). Among medicinal drugs, paracetamol, non-steroidal anti-inflammatory and antidepressants are mostly seen. Preventable adverse drug events (ADEs) are a common cause of ED visits, hospitalizations and death [3].

In our study in which those who applied to the Adult Emergency Service of the University Hospital were examined, 3.25% of 3879 forensic cases who applied to the Adult Emergency Service were Poisoning Cases. Of these, 57.14% were suicidal, 23.0% chemical substances poisoning, 12.70% CO poisoning, 7.93% food poisoning, 2.38% alcohol intoxication, 1.59% substance intake. The highest drug intake was 45.83% antidepressants, paracetamol 16.67%, nonsteroidal antiinflammatory drugs (NSAID) 12.50%, antipsychotics 10.42%, benzodiazepine 8.33%, and antibiotics 6.25%. It has been shown that 37.50% of antidepressants are selective serotonin reuptake inhibitors (SSRIs) and 8% are tricyclic antidepressants [4].

Over-the-counter analgesics are often used in suicide attempts. An analysis of suicide attempts presenting to the emergency department in Montreal two hospitals between 2009 and 2010. The most commonly used drugs in the study: acetaminophen (30%), antidepressants (37%), anxiolytics (30%), opioids (10%) and anticonvulsants (9%) were found among prescription drugs, cocaine (10%) was observed among drugs and recreational drugs.

It was seen that 16.7% of the patient were kept under observation with only symptomatic treatment while gastric lavage activated charcoal, gastric lavage, activated charcoal, antodote were applied in 83.3% of them. In most emergency departments, poisoning treatment is similar. Patients admitted to emergency services are initially evaluated for vital signs. Gastric lavage is performed properly and activated charcoal is given.

Gummin DD shown in their study that Emergency Medicine Service physicians frequently used 15% antidotal therapy [5].

Poisoning cases are a major cause of mortality and morbidity today and are a serious public health problem. The high rate of senescence and renal function tests at the time of application is important for the development of chronic renal failure in patients who are followed up for poisoning and receive extracorporeal therapy. Evaluation of vital signs during emergency service admission is very important in predicting mortality and the need for mechanical ventilation. Also, blood gas, hematological and biochemical parameters are extremely important in predicting mortality during admission. Blood gas analysis should be performed in all patients presenting to the emergency department due to poisoning [6].

Conclusion

In our study, drugs such as antidepressants and analgesics, which were detected at high rates in poisonings, admitted to the emergency department, they are among the important cases that should always be monitored closely.

References

1. Lund C, Vallersnes OM, Jacobsen D, Ekeberg O, Hovda KE.  Outpatient treatment of acute poisonings in Oslo: poisoning pattern, factors associated with hospitalization, and mortality. Scand J Trauma Resusc Emerg Med. 2012;20:1-10.
2. Shaun Greene. General Management of Poisoned Patients. In Judith E. Tintinalli, J. Stephan Stapczynski, O. John Ma, Donald M. Yealy, Garth D. Meckler, David M. Cline (Eds) Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition, Mc.Graw- Hill, USA 2016.  
3. Hancı H, Gurbuz N. Anual Evaluation of “Drug Poisonings, Emergency Service” Studies Published in Pubmed 01.01.2019-01.01.2020. Eurasian J Emerg Med. 2021;20(2): 65-70.
4. Gurbuz N. The Evaluation of The Poisonings Admitted to Emergency Service of University Hospital. J Clin Toxicol. 2021;11(2):472.
5. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017;55(10):1072-1252.
6. Kamiloğlu M, Köylü R, Köylü Ö, Cherry EF, Smart NB, BaykalnPÖ, Intoxication Patients admitted to Intensive Care and Extracorporeal Treatment Retrospective analysis. 24. National Multidisciplinary Clinical Toxicology/1. International Multidisciplinary Clinical Toxicology Congress, 25-27 May 2019, Konya. p.107