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Review
, 110 (41), 690-9; quiz 700

Common Causes of Poisoning: Etiology, Diagnosis and Treatment

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Review

Common Causes of Poisoning: Etiology, Diagnosis and Treatment

Dieter Müller et al. Dtsch Arztebl Int.

Abstract

Background: In 2011, German hospitals treated approximately 205 000 patients suffering from acute poisoning. Change is seen over time both in the types of poisoning that occur and in the indications for specific treatment.

Methods: This article is based on a selective review of the literature, with special attention to the health reports of the German federal government, the annual reports of the GIZ-Nord Poisons Center (the poison information center for the four northwestern states of Germany, i.e. Bremen, Hamburg, Lower Saxony and Schleswig-Holstein), and the recommendations of international medical associations.

Results: From 1996 to 2011, the GIZ-Nord Poisons Center answered more than 450 000 inquiries, most of which involved exposures to medical drugs, chemicals, plants, foods, or cosmetics. Poisoning was clinically manifest in only a fraction of these cases. Ethanol intoxication is the commonest type of acute poisoning and suicide by medical drug overdose is the commonest type of suicide by poisoning. Death from acute poisoning is most commonly the result of either smoke inhalation or illegal drug use. Severe poisoning is only rarely due to the ingestion of chemicals (particularly detergents and cleaning products), cosmetics, or plant matter. Medical procedures that are intended to reduce the absorption of a poison or enhance its elimination are now only rarely indicated. Antidotes (e.g., atropine, 4-dimethylaminophenol, naloxone, toluidine blue) are available for only a few kinds of poisoning. Randomized clinical trials of treatment have been carried out for only a few substances.

Conclusion: Most exposures to poisons can be treated with general emergency care and, if necessary, with symptomatic intensive-care measures. Poison information centers help ensure that cases of poisoning are dealt with efficiently. The data they collect are a useful aid to toxicological assessment and can serve as a point of departure for research projects.

Figures

Figure 1
Figure 1
Substances of mainly non-medical use that were most commonly involved in cases of acute poisoning treated in German hospitals in 2011 (4, 5). Alcohols by type: ethanol (1497), not further specified (1201), methanol (21), 2-propanol (39) (according to ICD-T51)
Figure 2
Figure 2
Medications, illegal drugs, and biologically active substances most commonly involved in cases of acute poisoning treated in German hospitals in 2011 (4, 5) T39 = analgesics (ca. 40% 4-aminophenol derivatives) T42 = hypnotics (ca. 50% benzodiazepines) and antiepileptic drugs T43 = antidepressants, neuroleptic drugs, psychotropic substances (not further classified) T40 = narcotics, methadone, hallucinogens (especially morphine and codeine) T50 = other medications, not further specified Mental and behavioral disturbances due to acute intoxication with: F10.0 = alcohol (ethanol) F11.0 = opioids F13.0 = hypnotics, sedatives F15.0 = stimulants F19.0 = multiple substance use
Figure 3
Figure 3
Inquiries about suspected quetiapine intoxication that were addressed to the GIZ-Nord Poisons Center compared to annual volume of quetiapine prescriptions (8, 9)
Figure 4
Figure 4
Treatments in German hospitals, for intoxication with stimulants, F15.0 (4)
Figure 5
Figure 5
Inquiries about gamma-hydroxybutyric acid (GHB) intoxications (data from the GIZ-Nord Poisons Center)

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