RESUMEN
AIM: To analyze the types, frequency and severity of plant poisonings in Switzerland over 29 years. METHODS: Retrospective analysis of severe poisonings with toxic plants reported to the Swiss Toxicological Information Center (STIC). Assessment of the causality, severity of symptoms and the types of plants involved. RESULTS: During the period under review the STIC registered 24 950 cases of contact with or ingestion of toxic plant material. In 99.4% of all cases the clinical course was either unknown, asymptomatic or associated with only minor symptoms (no hospitalization). Severe plant poisonings occurred in 152 cases. Detailed analysis was possible in 135 cases (23 children, 112 adults) including 5 lethal cases (all adults). The 24 plants involved produced the following severe symptoms: Atropa belladonna (42 cases): anticholinergic syndrome (42), acute psychosis (33), convulsions (2), coma (2). Heracleum mantegazzianum (18): severe photodermatitis (18). Datura stramonium (17): anticholinergic syndrome (17), psychosis (12), coma (2). Dieffenbachia (11): severe stomatitis (8), corneal lesions (3). Colchicum autumnala (10): diarrhea (10), liver necrosis (9), fatal multiorgan failure (2). Veratrum album (8): bradycardia ( < or = 40/min) (6), shock (5). Aconitum napellus (4): tachyarrhythmia (2), AV-block II/III (2). Aesculus hippocastanum (3): allergy (3), anaphylactic shock (2). Hyoscyamus niger (3): anticholinergic syndrome (3). Ricinus communis (3): diarrhea (3), toxic megacolon (1). Oenanthe crocata (2): convulsions (1), lethal coma (1). Taxus baccata (2): tachyarrhythmia (1), fatal asystole (1). Further single cases with severe poisonings were observed with Arum maculatum, Asarum europaeum, Chrysanthemum vulgare, Cyclamen persicum, Datura suaveolens, Glycyrrhiza glabra, Laburnum anagyroides, Lycopodium, Narcissus pseudonarcissus (lethal aspiration), Nerium oleander, Senecio vulgaris and Vicia faba. CONCLUSIONS: Potential and real intoxications with plant materials occurred in 7.2% of all cases registered at the STIC. However, among all plant cases only 0.6% were severe intoxications requiring hospitalization. Although severe plant intoxications are rare events, a small number of specific plants appear to be mainly responsible for continued serious plant poisoning in Switzerland. The present study has identified the plants with the highest toxicological risks and provides a data base for more rational prevention, diagnosis and treatment of plant poisoning cases in the future.
Asunto(s)
Intoxicación por Plantas/epidemiología , Adulto , Niño , Femenino , Humanos , Masculino , Intoxicación por Plantas/mortalidad , Plantas Tóxicas , Centros de Control de Intoxicaciones , Estudios Retrospectivos , SuizaRESUMEN
Accidental ingestions of noxious substances are frequent events during childhood, especially in children one to three years of age. In contrast, severe symptoms and a serious outcome of these intoxications have been observed rather rarely; therefore, it is very important to avoid unnecessary and potentially harmful therapeutic measures. An extensive body of information has been collected nationally and internationally, allowing an accurate risk assessment in a constantly increasing number of cases. If there is need for treatment at all, the early application of activated charcoal (dose: 1 g/kg body weight) will efficiently inhibit absorption of noxious substances in most instances. Whereas the first dose of activated charcoal is administered to block absorption, repeated administration (0.5 g/kg body weight, every 2 to 4 hours) has been shown to shorten half-life and enhance the nonrenal clearance of chemically different substances even after absorption. Only few substances like heavy metals, lithium, or alcohols are not adsorbed by activated charcoal. Whole bowel irrigation may be a valuable alternative in cases where activated charcoal has been shown to be ineffective. Poisoning with ferrum formulations is an instructive example of this type of intoxication. Gastric lavage and pharmacologically induced emesis are no longer considered a routine treatment in poisoning but rather a special therapeutic option for very special situations. In all cases of severe poisoning, maintenance of vital functions, applying the principles of emergency medicine, has to have first priority.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Intoxicación/terapia , Antídotos/uso terapéutico , Carbón Orgánico/uso terapéutico , Niño , Preescolar , Cuidados Críticos , Humanos , Lactante , Absorción Intestinal , Centros de Control de Intoxicaciones , Intoxicación/diagnóstico , Venenos , SuizaRESUMEN
A pilot study was performed in order to evaluate the usefulness of the Swiss Toxicological Information Center (STIC) in detecting cases of occupational illness. One hundred and fifty-two symptomatic occupational exposure cases were collected, comprising 3.2% of 4830 cases reported to the STIC between 1 April 1992 and 15 August 1992. In 114 cases a follow-up could be performed by a structured telephone interview. On the basis of these interview data it was estimated that 72% of the cases in small enterprises were reported to the STIC without additional notification to an occupational insurance fund. By contrast, only 28% of the occupational illness cases that occurred in companies employing more than 15 workers were not reported to an occupational insurance fund. This discrepancy could have resulted in part from the fact that occupational insurance in Switzerland is mandatory only for salaried employees, not for self-supporting persons. It is concluded that the monitoring of the occurrence of occupational illnesses in small-scale enterprises must be improved. Poison control centers could play a major role in this respect.
Asunto(s)
Enfermedades Profesionales/epidemiología , Centros de Control de Intoxicaciones/estadística & datos numéricos , Intoxicación/epidemiología , Sector Privado/tendencias , Adulto , Métodos Epidemiológicos , Femenino , Sustancias Peligrosas/envenenamiento , Humanos , Masculino , Enfermedades Profesionales/inducido químicamente , Proyectos Piloto , Prevalencia , Sistema de Registros , Suiza/epidemiologíaRESUMEN
Poisonings are frequently encountered in hospital emergency departments. Approximately 80% of poisonings occur by ingestion of toxic substances. The basic approach to the poisoned patient includes initial stabilization to correct immediate life-threatening problems, treatment to reduce absorption, measures to improve elimination of the toxin and the use of specific antidotes. Traditional gastric lavage is indicated today in severely intoxicated patients if they present within the first few hours of ingestion. Administration of activated charcoal is recommended in most cases of poisoning. It should be administered early, in an adequate dose and repeatedly if necessary.
Asunto(s)
Intoxicación/terapia , Enfermedad Aguda , Antídotos/uso terapéutico , Carbón Orgánico/uso terapéutico , Terapia Combinada , Cuidados Críticos , Lavado Gástrico , HumanosRESUMEN
Intoxications with drugs, household products and plants include approximately 70% of all cases reported to the STIZ. Among drugs the most frequent severe intoxications occur with benzodiazepines and antidepressives; therefore, the toxicological risk of these substances are investigated in more detail. In children, accidental intoxications with household products are most frequent. In these cases special emphasis must be put on preventive measures. Plants only rarely lead to severe intoxications; however, if toxic symptoms do occur, the analysis of their causality and overall risk for the patient can be a difficult task and frequently requires the involvement of a plant specialist.