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General and Risk Management, Patient Safety (including: medication errors, quality control)
Drug poisoning: a reason for care in a hospital emergencies unit
  1. I. Larrodé,
  2. J.M. Real,
  3. C. Garcés,
  4. Y. Alonso,
  5. J. Povar,
  6. M.R. Abad-Sazatornil
  1. 1Miguel Servet Hospital, Pharmacy, Zaragoza, Spain
  2. 2Miguel Servet Hospital, Emergency, Zaragoza, Spain

Abstract

Background Intoxication by drugs requires often quick attention in the emergency department (ED), so an antidote kit to combat drug intoxication would be helpful.

Purpose To analyse intoxication by drugs treated in the emergency department as a preliminary step to making up an antidote kit.

Materials and methods All patients treated in ED for drug intoxication in a Spanish hospital were included, from January to June 2010. Data collected were: sex, age, cause, measures, days of stay in ED, admission, ward, duration of admission, complications.

Results Data from 137 patients were analysed, 79 females (57.7%), median (minimum-maximum) age was 37 (92–0) years. 77 patients (56.2%) were intoxicated by drugs affecting the central nervous system, 19 (13.9%) by analgesic/anti-inflammatory drugs, 11 (8.0%) by cardiovascular system drugs, 5 (3.6%) by systemic endocrine drugs and the drug(s) involved were unknown in 21 (15.3%) of cases. In 20.4% the intoxication was due to several drugs. 65.0% needed drug-specific treatment. Gastric lavage was necessary in 29.9%. In addition, activated charcoal was administered in 32.1%, flumazenil in 25.5%, naloxone in 4.4% and N-acetylcysteine in 4.4%. Other drugs used were norepinephrine, digoxin-specific antibody (Fab) fragments, a potassium chelator, antiemetics, blood coagulation factors and anticholinergics. The median stay in ED was 1 (0–2) day. 27 patients (19.7%) were admitted and 2 (1.5%) requested voluntary discharge. Of the inpatients, 26.9% were to the psychiatry ward, 19.2% to the critical care unit, cardiology and internal medicine wards, and 15.4% to the paediatric ward. The stay in hospital was 6 (17–0) days. Seven patients had complications related to intoxication (three acute kidney injury, two rhabdomyolysis, two aspiration pneumonia) but none of them died.

Conclusions The analysis of intoxications treated in ED will guide the contents of the antidote kit. It is important to increase the control of drugs that affect the central nervous system.

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