Poison Center, MacKay Memorial Hospital

2023年7月9日星期日

Current Ten Clinical Studies on New Psychoactive Substances in Taiwan

Year	Journal	University, Hospital.	Finding, Conclusion	Reference
2016	Subst Abuse Treat Prev Policy	Kaohsiung Medical University	Controlled NPS items in Taiwan were far less than those in Korea, but the quantity of total NPS seizures, especially with ketamine, was much larger in Taiwan than in Korea.	1
2017	Forensic Sci Int	Kaohsiung Medical University	Japan is the most proactive country in terms of the NPS regulation with 41% of the total number of controlled NPS in Northeast Asia, followed by South Korea (21%), China (28%), Taiwan (10%)	2
2020	J Formos Med Assoc	National Taiwan University Hospital	The most common NPS was ketamine (21.7%), followed by synthetic cathinones (14.8%). Polysubstance use was more common in the NPS group than in the traditional group. Most patients were men (78.3%)	3
2022	Clin Toxicol (Phila) .	Linkou Chang Gung Memorial Hospital	The most frequently detected drug was methamphetamine/amphetamine, followed by synthetic cathinones, ketamine and its two analogs, and opioids. Younger patients and women were more likely to have NPS detected in their urine samples. NPS-positive cases frequently experienced chest pain tachycardia and suicide attempt/non-suicidal self-harm whereas depressed consciousness was less frequent among NPS-positive cases than among other illicit drug-positive cases.	4
2022	J Formos Med Assoc	National Taiwan University College of Medicine	546 (73.7%) men and 195 (26.3%) women were enrolled. Compared to men, women were younger (32.03 ± 10.86 vs. 36.51 ± 10.84 years, p < 0.001) and more likely to use new psychoactive substances (NPS). Men were more likely to have HIV infection, whereas women were more likely to report psychiatric comorbidities. Women were less likely to have aggressive behaviors. The likelihood of rhabdomyolysis and intensive care unit admission was higher in men (p < 0.001).	5
2022	Clin Toxicol (Phila)	National Taiwan University College of Medicine	Tachycardia, hyperthermia, and rhabdomyolysis were more common among cathinone users than among meth/amphetamine users presented to EDs.	6
2022	J Formos Med Assoc	Taipei City Hospital	High suicidality and high psychiatric comorbidities in multiple illicit drug users call for special need for suicide screening and a more integrated care incorporating psychiatric and substance treatment.	7
2022	Toxics	Linkou Chang Gung Memorial Hospital	The mortality NPS users were older, with deep coma, faster heart rate and respiratory rate, lower blood pressures and O2 room air saturation, more seizures, abnormal breath sounds, and had urine incontinence compared to the survivor patients. The mortality patients also had acute kidney injury, higher potassium, blood sugar, liver function test, and lactate level.	8
2023	J Forensic Leg Med	Mackay Memorial Hospital	NPS users are relatively younger, are more likely to experience facial flush and palpitation and engage in more self-harm, violence, and suicide than non-NPS drug users.	9
2023	Medicine (Baltimore)	MacKay Memorial Hospital	The NPS users were significantly younger than those with negative results on toxic testing (26.4 vs 37.5, P = .005). The heart rate of NPS users was significantly faster than that of the group with negative results of toxic testing (111.1 vs 93.5 beats per minute, P = .046). The heartbeats of INPS group were also significantly faster than those with a negative result in toxicology screen (119.6 vs 93.5 beats per minute, P = .024). Those who used classical illicit drugs combined with NPS had significantly higher palpitation than those with negative results of toxic testing (27.3% vs 3.1%, P = .017).	10

1. https://pubmed.ncbi.nlm.nih.gov/27663984/

2. https://pubmed.ncbi.nlm.nih.gov/28088088/

3. https://pubmed.ncbi.nlm.nih.gov/32037264/

4. https://pubmed.ncbi.nlm.nih.gov/35315299/

5. https://pubmed.ncbi.nlm.nih.gov/35365378/

6. https://pubmed.ncbi.nlm.nih.gov/35438590/

7. https://pubmed.ncbi.nlm.nih.gov/35484001/

8. https://pubmed.ncbi.nlm.nih.gov/35878292/

9. https://pubmed.ncbi.nlm.nih.gov/36571928/

10. https://pubmed.ncbi.nlm.nih.gov/37352073/

Edited by Yu-Jang Su July, 9, 2023

2023年6月12日星期一

Amphetamine poisoning

Substance

Amphetamine

Common name

安仔, 安公子 [1]

Involving system and Presentation

- CV: flushing, diaphoresis, hypertension, vasoconstriction, lung edema, heart failure, shock. Tachycardia [1]

- Neuro and psychiatric: agitation, delusion, hyperactivity, tremor, delirium, rigidity, acute psychosis [2], paranoid schizophrenia, hallucination. [1] Toxic encephalopathy. [3].

- Hyperthermia, rhabdomyolysis, myoglobinuria. [1]

- Acute kidney injury. [1]

- acute porphyria. [4].

Antidote / Treatment

- ACLS or shock, arrhythmia, hypertension, tachycardia.

- Intubation when respiratory failure [1]

- GI decontamination within 1 hour. Activated charcoal, 1gm/kg with laxative agent [1]

- Benzodiazepine, barbiturate for seizure, delirium. [1]

- Fever: sedative and external cooling. [1]

- Rhabdomyolysis – hydration to keep urine output 1—2 ml./kg BW/hour. [1]

- VPC – benzodiazepine +/- lidocaine. [1]

- - hypotension – fluid challenge or inotropic agent. [1]

Disposition

- PCO2 ≥ 51 mmHg, serum bicarbonate ≤ 22.6 mEq/L, and loss of consciousness on admission could be considered as prognostic factors of mortality [5]

- The mortality rate was 5.4% [5]

References

[1]急性中毒救命術三版急診急診醫學會p.119-128.

[2]. Bramness JG, Rognli EB. Psychosis induced by amphetamines. Curr Opin Psychiatry. 2016 Jul;29(4):236-41. doi: 10.1097/YCO.0000000000000254. PMID: 27175554.

[3]. Bojsen JA, Lunau L, Nguyen NT, Rasmussen BSB. [Amphetamine-induced toxic encephalopathy]. Ugeskr Laeger. 2022 May 23;184(21):V12210924. Danish. PMID: 35656615.

[4]. Kiew CK, Lam ASEL. Unexpected presentation of acute porphyria. BMJ Case Rep. 2021 Jun 29;14(6):e241580. doi: 10.1136/bcr-2021-241580. PMID: 34187794; PMCID: PMC8245470.

[5] Rahimi M, Lookzadeh S, Sadeghi R, Soltaninejad K, Shadnia S, Pajoumand A, Hassanian-Moghaddam H, Zamani N, Latifi-Pour M. Predictive Factors of Mortality in Acute Amphetamine Type Stimulants Poisoning; a Review of 226 Cases. Emerg (Tehran). 2018;6(1):e1. Epub 2018 Jan 10. PMID: 29503826; PMCID: PMC5827041.

Edited by Yu-Jang Su June 12, 2023

2023年5月1日星期一

Glufosinate

Substance

Glufosinate-Ammonium 13.5%SL

Common name / Trade name

強手(固殺草); 草銨膦

Involving system

- Mechanism: glutamine synthetase-inhibiting [1]

- Interferes with glutamate synthetase activity [2]

- Neurotoxicity.

- Mental disturbances [3]

- Hematological changes

- Gastrointestinal effects [3], nausea.

Presentation

- Altered mental status [4] amnesia [2]

- Fever [2]

- Arrhythmia, [2]

- Seizure, 31.5% [5]

- higher initial ammonia levels. [6]

- respiratory failure. [7]

- Vasogenic edema in striatum [8]

- Shock [2]

Antidote and Treatment

- Activated charcoal, Carbomix [2].

- IVF, monitoring urine output.

- Intubation if respiratory failure

- Monitoring.

- supportive care.

- benzodiazepine for seizure

- Without antidote.

- Hemodialysis [2]

Disposition

- Observe 48 hours, [2]

- Age > 70 years and GCS score < 9 at triage could be predictors of mortality in patients. [4]

- An initial serum ammonia level >151 µg/dL was an independent early predictor of in-hospital mortality [9]

- Older age (≥ 61 years; adjusted OR 4.9) and larger amount of glufosinate ingestion (≥ 13.9 grams; adjusted OR 25.2) were positively associated with the development of severe toxicity [10].

- 6.1% to 17.7% died following deliberate glufosinate ingestion. [2, 10]

References

[1]. https://pubmed.ncbi.nlm.nih.gov/36963955/

[2].Goldfrank’s Toxicology Emergencies p1478—79. 11^th ed.

[3] https://pubmed.ncbi.nlm.nih.gov/9491336/

[4] https://pubmed.ncbi.nlm.nih.gov/34392143/

[5]. https://pubmed.ncbi.nlm.nih.gov/28421825/

[6] https://pubmed.ncbi.nlm.nih.gov/36399183/

[7]. https://pubmed.ncbi.nlm.nih.gov/24044532/

[8] https://pubmed.ncbi.nlm.nih.gov/19581091/

[9]. https://pubmed.ncbi.nlm.nih.gov/31146590/

[10] https://pubmed.ncbi.nlm.nih.gov/22480254/

Edited by Yu-Jang Su May 1st, 2023.

2023年4月12日星期三

Inoxicated / Poisoning-Related Coma Blister

Inoxicated / Poisoning-Related Coma Blister
Year	Country	Age	Gender	Substance	References
2022	US	82	F	lorazepam for insomnia	1
2012	Brazil	45	F	clonazepam, promethazine, oxcarbazepine and quetiapine	2
2009	UK			barbiturate	3
2007	UK	53	F	Acetaminophen 500mg, codeine 30mg	4
2002	Germany			theophylline toxicity	5
2002	Canada			amitriptyline overdose	6
1991	Australia	25	M	carbon monoxide	7
1990	Ichilov	75		200 mg oxazepam	8
1972				BARBITURATE	9