Antidotes: availability, use and cost in hospital and extra-hospital emergency services of Catalonia (Spain).
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Biomedical subjects
Publications and source records attributed to S Nogué.
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About 5% of the patients admitted to emergency departments with poisonings are seriously ill and need admission to intensive care units (ICUs). This paper presents the result of three multicentric studies carried out in Spain during the last ten years. A study was made of 6 ICUs in 1980, 41 in 1987 and 15 in 1990 with a total of 596 patients. The average age (36) remained stable throughout, but the number of female cases decreased each time. The most frequent cause (79%) was attempted suicide. The products used most frequently were therapeutic drugs (82, 71 and 58%) followed by drugs of abuse, and then agricultural, household and industrial products. We observed a progressive decrease in barbiturates (54, 15 and 2%) and an increase in benzodiazepines and cyclic antidepressants. Therapeutic methods used were mostly gastric lavage (64%), activated charcoal (35%), forced diuresis (43%), extracorporeal therapy (11%) and antidotes. The mortality rate fluctuated between 6.4 and 9.1%, being significantly higher with poisoning by non-therapeutic drugs. In conclusion, the most common poisoning admitted to our ICUs was by psychoactive drugs in suicide attempts. We observed the under-use of activated charcoal and an excessive usage of kidney and extracorporeal methods. The prognosis was worse for poisonings with non-therapeutic drugs.
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We present four cases of heavy metal poisoning (mercury, lead, bismuth and arsenic) in which plain chest and/or abdominal assisted in the differential diagnosis of the clinical picture manifested upon admission at our Emergency Department. The patients suffering from mercury, lead, and bismuth poisoning recovered some weeks after treatment was started. However, the patient with arsenic trioxide poisoning developed cardio-circulatory collapse leading to death three days after admission.
Five cases of acute poisoning by scopolamine bought as cocaine, are reported. All the cases presented a serious anticholinergic syndrome which needed physostigmine administration. The presence of scopolamine in urine and the specimen sniffed was demonstrated in all the cases.
The clinical, radiological and analytical aspects, and the complications observed in 16 cases of swallowing or insertion into the rectum of illicit drugs ("body-packing") are described. The drugs detected were heroin (6 cases), cocaine (5 cases) and cannabis (5 cases). In 15 cases abdominal plain X-rays were useful in the detection of the drug packages, their position and progression in the gastrointestinal tract and the presence of complications. The most valuable finding for radiologic diagnosis was the presence of a radiolucent halo surrounding the drug packages, or "double condom" sign, which was observed in 13/15 cases (87%). Urine analysis was positive for opiates or metabolites of cocaine in 7/9 cases (78%). One case presented acute heroin intoxication and three subjects gastric or intestinal obstruction requiring surgical treatment. In another case a packet, which had been retained in the stomach for five days, was extracted by upper gastrointestinal endoscopy using a Dormia basket with no complications.
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A case of severe ethylene-glycol intoxication is presented in which there were potentially fatal plasma levels, neurological manifestations and acute renal failure and which was treated with ethanol and hemodialysis. Crystal deposits, normal glomeruli and severe tubular affectation suggestive of direct cytotoxic action, were found in renal biopsy, which was performed during the anuric phase. The evolution was favorable with no neurologic sequelae, diuresis re-onset on day 17 and return of normal renal function.
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