Poisoning and Overdose
3
7/27/2019 Poisoning and Overdose http://slidepdf.com/reader/full/poisoning-and-overdose 1/3 POISONING AND OVERDOSE Poisoning is a major public health issue and each year gives rise to about 500 000 attendances to emergency departments in the United Kingdom and around 140 000 admissions to hospital.[1] This equates to 1-2% of all emergency department attendances, which is similar to the number of patients who present to hospital as a result of heart attack. Emergency department attendances because of poisoning have gradually increased over recent years, although the reasons for this are poorly understood.[2] In the UK, poisoning results in around 2000 deaths each year, and less than a third of these occur in hospital.[2] [3] Therefore, data from hospital attendances represent only the “tip of the iceberg,” and the true scale of self poisoning in the community might be much greater. We present an overview of common clinical presentations from poisoning, the general clinical approach to care, and an overview of the management of paracetamol toxicity as a specific example. Top Patterns of poisoning Top Intentional overdose Self poisoning accounts for nearly all toxicology cases in acute healthcare services. Patients might have been exposed to any one of a wide variety of different drugs, chemicals, or other toxic hazards.[4] In the UK attempted suicide was considered a criminal offence until the introduction of the Suicide Act 1961 in England and Wales. Since then, the suicide rate has fallen, although there has been an alarming recent increase in suicide among young men.[2] [5] The mode of suicide has evolved, and self poisoning has increased whereas violent deaths have decreased.[5]Introduction of the Suicide Act led to a substantial increase in the number of patients seeking medical attention after self poisoning and emergence of specialist poisoning treatment units in the 1960s. [6] The type of agent used in self poisoning depends on what is most readily accessible to the patient.[7] The most common methods in the 1960s involved barbiturates, high dose aspirin, and carbon monoxide. Today, paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs have substantially replaced aspirin as an analgesic, and barbiturates have been replaced by benzodiazepines and novel hypnotic agents. Table 1 shows some contemporary means of self poisoning. [8] Clinical advice on the management of suspected poisoning in the UK and Republic of Ireland is available via TOXBASE, an internet resource that is maintained by the National Poisons Information Service and supported by advice via
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Transcript of Poisoning and Overdose
7/27/2019 Poisoning and Overdose
http://slidepdf.com/reader/full/poisoning-and-overdose 1/3
POISONING AND OVERDOSE
Poisoning is a major public health issue and each year gives rise to about 500 000
attendances to emergency departments in the United Kingdom and around 140 000
admissions to hospital.[1] This equates to 1-2% of all emergency departmentattendances, which is similar to the number of patients who present to hospital as a
result of heart attack. Emergency department attendances because of poisoning have
gradually increased over recent years, although the reasons for this are poorly
understood.[2] In the UK, poisoning results in around 2000 deaths each year, and less
than a third of these occur in hospital.[2] [3]Therefore, data from hospital attendances
represent only the “tip of the iceberg,” and the true scale of self poisoning in the
community might be much greater. We present an overview of common clinical
presentations from poisoning, the general clinical approach to care, and an overview of
the management of paracetamol toxicity as a specific example.Top
Patterns of poisoning
Top
Intentional overdose
Self poisoning accounts for nearly all toxicology cases in acute healthcare services.
Patients might have been exposed to any one of a wide variety of different drugs,
chemicals, or other toxic hazards.[4]
In the UK attempted suicide was considered a criminal offence until the introduction of the Suicide Act 1961 in England and Wales. Since then, the suicide rate has fallen,
although there has been an alarming recent increase in suicide among young
men.[2] [5] The mode of suicide has evolved, and self poisoning has increased whereas
violent deaths have decreased.[5]Introduction of the Suicide Act led to a substantial
increase in the number of patients seeking medical attention after self poisoning and
emergence of specialist poisoning treatment units in the 1960s.[6]
The type of agent used in self poisoning depends on what is most readily accessible to
the patient.[7] The most common methods in the 1960s involved barbiturates, high dose
aspirin, and carbon monoxide. Today, paracetamol (acetaminophen) and non-steroidal
anti-inflammatory drugs have substantially replaced aspirin as an analgesic, and
barbiturates have been replaced by benzodiazepines and novel hypnotic agents. Table
1 shows some contemporary means of self poisoning.[8]
Clinical advice on the management of suspected poisoning in the UK and Republic of
Ireland is available via TOXBASE, an internet resource that is maintained by the
National Poisons Information Service and supported by advice via
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