RESUMEN
INTRODUCTION: Poisonings are a worldwide preventable public health problem that affects the general population. OBJECTIVE: To epidemiologically characterize BZ and AD poisonings registered in Chile between 2002 and 2019. METHODS: An observational retrospective study of poisonings registered in the medical outcome report system of the Chilean Ministry of Health was conducted. The World Health Organization International Classification of Disease codes T42.2, T43.0 and T43.2 were included. RESULTS: 22,807 poisonings associated with BZ or AD were identified, representing 0.08% of all hospitalizations. Poisoning rates distribution were established at regional and national level. There were 9.8% of accidental events, 63.7% of intentional events, and 26.5% of undetermined cases. The highest accidental and intentional poisoning rates were estimated at the ages of 0 to 4 and 15 to 19 years old respectively. Poisoned patients remained hospitalized on average for 3.4 days. 0.3% of cases were related to death of patients. CONCLUSIONS: Poisoning events were characterized according to the studied variables. National poisoning rates decreased over the years with prevalence of those intentional events linked to women. Efforts should be made in creating poisoning prevention campaigns focused on age-based groups in the general population.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Benzodiazepinas/envenenamiento , Antidepresivos/envenenamiento , Intoxicación/epidemiología , Chile/epidemiología , Prevalencia , Estudios Retrospectivos , Distribución por Sexo , Distribución por Edad , Hospitalización/estadística & datos numéricosRESUMEN
INTRODUCTION: Poisonings are a worldwide preventable public health problem that affects the general population. OBJECTIVE: To epidemiologically characterize BZ and AD poisonings registered in Chile between 2002 and 2019. METHODS: An observational retrospective study of poisonings registered in the medical outcome report system of the Chilean Ministry of Health was conducted. The World Health Organization International Classification of Disease codes T42.2, T43.0 and T43.2 were included. RESULTS: 22,807 poisonings associated with BZ or AD were identified, representing 0.08% of all hospitalizations. Poisoning rates distribution were established at regional and national level. There were 9.8% of accidental events, 63.7% of intentional events, and 26.5% of undetermined cases. The highest accidental and intentional poisoning rates were estimated at the ages of 0 to 4 and 15 to 19 years old respectively. Poisoned patients remained hospitalized on average for 3.4 days. 0.3% of cases were related to death of patients. CONCLUSIONS: Poisoning events were characterized according to the studied variables. National poisoning rates decreased over the years with prevalence of those intentional events linked to women. Efforts should be made in creating poisoning prevention campaigns focused on age-based groups in the general population.
Asunto(s)
Antidepresivos , Benzodiazepinas , Humanos , Chile/epidemiología , Femenino , Adolescente , Masculino , Estudios Retrospectivos , Benzodiazepinas/envenenamiento , Adulto , Adulto Joven , Niño , Lactante , Preescolar , Persona de Mediana Edad , Antidepresivos/envenenamiento , Anciano , Distribución por Edad , Distribución por Sexo , Hospitalización/estadística & datos numéricos , Prevalencia , Intoxicación/epidemiología , Recién NacidoAsunto(s)
Humanos , Intoxicación/complicaciones , Intoxicación/diagnóstico , Intoxicación/terapia , Metanol/envenenamiento , Antidepresivos/envenenamiento , Fenotiazinas/envenenamiento , Intoxicación por Organofosfatos/diagnóstico , Intoxicación por Organofosfatos/terapia , Metahemoglobinemia/terapiaRESUMEN
Since its approval in the United States, fentanyl has become increasingly popular for the medical management of pain and as a substance of abuse. Fentanyl is unique among the opioids in its widespread use with a transdermal delivery system, which contributes to its unique pharmacokinetics and abuse potential. We examined the demographics of deaths with fentanyl identified on toxicologic analysis and reviewed specific challenges in the laboratory detection of postmortem fentanyl levels. The New Mexico Office of the Medical Investigator database was searched for all cases from January 1986 through December 2007 with fentanyl reported as present or quantified. Those deaths with a cause of death identified as drug overdose were then analyzed separately. From 1986 to 2007, 154 cases were identified with fentanyl present in postmortem samples, with 96 of the cases identified as fentanyl-related drug overdoses. The number of fentanyl-related deaths has increased over the past 20 years, corresponding to both statewide increases in the medical use of fentanyl and the abuse of prescription opioids. The demographics of these fentanyl-related overdoses showed that subjects were more likely to be female, white non-Hispanic, and older than those in previously described overdose deaths. Several cases were identified with central and peripheral blood samples and antemortem and postmortem samples available for fentanyl quantification. Given the uncharacteristic demographics of fentanyl-related deaths and the complexity of the laboratory analysis of fentanyl, forensic scientists must use caution in both the detection and interpretation of fentanyl concentrations.
Asunto(s)
Analgésicos Opioides/envenenamiento , Sobredosis de Droga/mortalidad , Fentanilo/envenenamiento , Accidentes/mortalidad , Administración Cutánea , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/sangre , Antidepresivos/sangre , Antidepresivos/envenenamiento , Médicos Forenses , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Fentanilo/sangre , Toxicología Forense , Cromatografía de Gases y Espectrometría de Masas , Homicidio/estadística & datos numéricos , Humanos , Hipnóticos y Sedantes/sangre , Hipnóticos y Sedantes/envenenamiento , Masculino , Persona de Mediana Edad , New Mexico/epidemiología , Grupos Raciales/estadística & datos numéricos , Estudios Retrospectivos , Distribución por Sexo , Suicidio/estadística & datos numéricos , Espectrometría de Masas en Tándem , Adulto JovenRESUMEN
La intoxicación por psicofármacos es motivo frecuente de consulta a centros de información toxicológica y servicios de urgencia. Habitualmente son por ingestión accidental en niños y por sobredosis intencional en adultos, pero también puede suceder por interacciones con otras sustancias o medicamentos que potencien la toxicidad del psicofármaco. Las maniobras básicas de soporte vital son el pilar de tratamiento del intoxicado grave y las acciones que buscan disminuir la absorción sistémica de la sustancia aminoran la progresión y duración de sus efectos. El uso de antídotos no está recomendado en todos los casos, estos pueden aumentar el riesgo de complicaciones graves. Los objetivos de este artículo son entregar nociones de las manifestaciones clínicas, del manejo inicial y de las complicaciones más frecuentes y graves del intoxicado por ingesta de psicofármacos. Serán agrupados por familia de acuerdo a su clase y uso terapéutico, describiendo los mecanismos de toxicidad. En algunos de ellos hay recomendaciones de consenso respecto del manejo prehospitalario y la derivación a centros de alta complejidad.
The psychotropic drugs poisoning is a frequent cause of calls to Toxicology Centers and consults to emergency departments. Accidental ingestion is frequent in children; otherwise intentional overdose happens in adults. However, interactions with other substances may increase the drugs toxicity. Basics manoeuvres of vital support are the most important facts in the treatment of the severely poisoned patient. The reduction of drug´s absorption decreases the progression and time effect of the drug. The antidotes are not recommended for all cases because they may increase the risk of severe complications. The objective of this article is to provide information about clinical manifestations, basic management and frequent complications in the severely poisoned patient. We will describe the mechanism of drugs toxicity by type and therapeutic use. For some of them, there are evidence - based consensus guidelines for out-of-hospital management and emergency department refer.
Asunto(s)
Humanos , Sobredosis de Droga , Psicotrópicos/envenenamiento , Antidepresivos/envenenamiento , Benzodiazepinas/envenenamientoRESUMEN
Suicide attempts in children are an important worldwide cause of morbidity and mortality and an emerging reason for admission in Pediatric Critical Care. Objective: Identify the epidemiologic and clinical characteristics of patients with drug poisoning with a suicide purpose as an admission cause in a Chilean Pediatric Intensive Care Unit (PICU). Design: Retrospective observational study. Setting: 14 beds PICU of a tertiary care public teaching hospital in Santiago de Chile. Material and Method: All patients admitted to the PICU between January 2005 and December 2008 for self-inflicted drug poisoning with an expressed intention of suicide were included. Analysis of the PICU clinical chart was performed with sampling on an excel data base. For seasonal distribution we used statistical analysis Xil. Results: 178 of 3045 PICU admissions were diagnosed as drug poisoning (5,8 percent), 108 of them for suicide attempts (60,6 percent).The number of annual patients increased, with highest incidence in spring and autumn and lowest in winter. Mean and median age was 13 years, 8,4 percent less than 12 years. 88,9 percent were females. They used polipharmacy in 57 percent. Drugs were taken from home. Antidepressants and sedatives were the most often used. An underlying psychiatric condition was present in 100 cases (92,6 percent). Associated factors were family disfunction, school problems, abuse and violation and bullying. Mean PICU stay was 1,46 days with 16,7 percent requiring transient mechanical ventilation No death was reported in this serie. Conclusions: The number of cases of suicide attempt via drug ingestion as a motive for admission in PICU is increasing, causing a raising number of short and transient admissions, more in spring less in winter. Risk factors were mostly an underlying psychiatric disorder and family disfunction.
Introducción: El intento de suicidio en pediatría, via ingestión de fármacos, es una importante causa de mor-bimortalidad en el mundo y un creciente motivo de ingreso a cuidados intensivos. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes con intoxicación por fármacos con un intento de suicidio, como causa de ingreso a una Unidad de Cuidados Intensivos Pediátricos en Chile (UC1P). Diseño: Estudio retrospectivo observacional. Pacientes y Método: UClP de 14 camas críticas en un hospital pediátrico de Santiago. Se incluyeron todos los pacientes ingresados a la UClP debido a intento de suicidio por ingestión de fármacos, entre enero 2005 a diciembre 2008. Resultados: 178 de 3 045 egresos se debieron a intoxicación por fármacos (5,8 por ciento) ,108 de ellos por intento de suicidio (60,6 por ciento). La tendencia observada es a un incremento anual, con mayor incidencia en primavera y otoño, y menor en invierno. La media y mediana de edad fue de 13 años, 8,4 por ciento menor de 12 años. 88,9 por ciento fueron mujeres, Se utilizó polifarmacia en un 57 por ciento con fármacos disponibles en el hogar. Antidepresivos y sedantes fueron los más usados. Patología psiquiátrica de base se diagnosticó en un 92,6 por ciento de los casos. Factores asociados fueron disfunción familiar, problemas en el colegio, abuso y violación, bullying. La estadía promedio en UClP fue de 1,5 días, requiriendo un 16,7 por ciento ventilación mecánica transitoria. No hubo fallecidos en esta serie. Conclusiones: El intento de suicidio por ingestión de fármacos como motivo de ingreso a UClP ha aumentado, requiriendo estadías cortas y transitorias, mayormente en primavera y menos en invierno. Factores asociados fueron patología psiquiátrica de base y disfunción familiar.
Asunto(s)
Humanos , Masculino , Adolescente , Femenino , Niño , Intoxicación/epidemiología , Intento de Suicidio/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Antidepresivos/envenenamiento , Chile/epidemiología , Intoxicación/psicología , Hipnóticos y Sedantes/envenenamiento , Estudios Retrospectivos , Factores de Riesgo , Estaciones del Año , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricosAsunto(s)
Humanos , Bupropión/envenenamiento , Ciclohexanoles/envenenamiento , Depresión/tratamiento farmacológico , Mianserina/envenenamiento , Antidepresivos/envenenamiento , Bupropión/farmacología , Ciclohexanoles/farmacología , Sobredosis de Droga , Mianserina/análogos & derivados , Mianserina/farmacologíaRESUMEN
Os autores realizaram uma revisäo de informaçöes e artigos, a respeito dos antidepressivos, mostrando além de características gerais, descriçöes de suas respectivas intoxicaçoes e tratamentos, na certeza de que a ausência de terapêutica específica, o reconhecimento do quadro e a rápida instauraçäo de medidas de suporte adequadas seräo de grande valia
Asunto(s)
Humanos , Antidepresivos/envenenamiento , Sobredosis de Droga/tratamiento farmacológicoRESUMEN
OBJECTIVE: Suicide by drug overdose is a major public health problem, and antidepressant medications are the most common agent involved. European studies suggest differences in the rates of suicide by overdose among antidepressants, but no reports have been published for the United States. We estimated the comparative risks of suicide attempts and suicides, and the relative risk of fatality in the event of an overdose for the major antidepressants currently marketed in the United States. DATA SOURCES: Information regarding suicide attempts and suicides by antidepressant overdose was obtained from the published reports of the Drug Abuse and Warning Network and the annual report of the American Association of Poison Control Centers, and corrected for differences in total annual prescriptions using data from the National Prescription Audit. RESULTS: The risk of a suicide attempt did not appear to differ among antidepressants. The tricyclic antidepressants were associated with a higher rate of death in the event of an overdose than the newer nontricyclic antidepressants in both the annual report of the American Association of Poison Control Centers and the Drug Abuse and Warning Network data. The chance of death after an overdose was greater for desipramine hydrochloride than for other tricyclics. CONCLUSION: The higher risk of suicide with tricyclics vs nontricyclics may be explained by a higher rate of death from overdose rather than more suicide attempts. Tricyclics carry the risk of greater cardiotoxicity. The basis for the even higher rate of death/overdose of desipramine is not known and requires further research. If these findings are replicated in a case-control study design, they have important implications for the choice of an antidepressant for the depressed patient at risk for suicidal behavior.
Asunto(s)
Antidepresivos/envenenamiento , Intento de Suicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Antidepresivos Tricíclicos/envenenamiento , Sobredosis de Droga/epidemiología , Sobredosis de Droga/psicología , Humanos , Intento de Suicidio/psicología , Estados Unidos/epidemiologíaRESUMEN
La intoxicación por antidepresivos tricíclicos (ADT) es poco frecuente en nuestra unidad de cuidados intensivos (menor del 1//). Los pacientes pueden presentar signos y síntomas de bloqueo colinérgico tanto periférico (taquicardia, midriasis, lleo adinámico) como central (coma, delirio, convulsiones, agitación), asociado a trastornos de la conducción AV y del ritmo cardíaco que pueden amenazar la vida. El tratamiento incluye la intubación endotraqueal, asistencia ventilatoria mecánica, lavado gástrico, alcalinización sistemática metabólica y respiratoria y el uso de drogas antiarrítmicas. Tanto la diuresis forzada como la hemodiálisis y la diálisis peritoneal son inefectivas para remover los ADT