Recent Ten Articles Describing Overdose / Poisoning in Seasonality

 

Year	Country	Major Finding	References
2023 Aug	Taiwan	Intentional drug overdose, IDO occurred most frequently in spring (32.1%), particularly in male patients (28/49 male cases).   First-time IDO occurred most frequently in spring (51/133 first-time cases)   Repeat IDO occurred most frequently in autumn (20/63 repeat cases).   Female conflict with father and/or boyfriend, and personality disorder in patients who overdosed, showed seasonality with a spring peak.   Hospital admission rate was highest in winter (10/45 winter cases [22.2%]).	[1]
2023 Jul	China	Female patients accounted for a higher proportion (72.5%), and the incidence of suicide was higher in winter than other seasons.   Among the 109 psychiatric patients, 60 patients (55.0%) had a history of major depressive disorder   Thirty-seven patients (33.9%) experienced severe physical complications caused by drug overdose, with lung infections being the most common.   2 patients (1.8%) older than 80 failed to survive.	[2]
2023 Aug	UK	The rate peaked in Spring and was 1.07 (95% CI = 1.04-1.09) times higher in April than in October.   The rate at New Year was 1.28 (95% CI = 1.17-1.41) times higher than on non-holidays; and this peak was only present for deaths that were not related to opioids.   The rate was higher on Saturday than on other weekdays. We did not find evidence that the number of deaths varied by week-of-month.	[3]
2021 Dec	US	Show the spring months have the most consistent increases in overdose deaths and overdose calls for service across years we studied.	[4]
2020 Nov	US	Showed that the number of cases associated with poisoning suicide attempts peaked in the Spring and dipped in the Fall.   Regression analysis showed higher numbers of suspected suicide attempts from intentional overdose in spring compared with winter by 1.07 times (p = 0.003), and on Sunday (p < 0.001), Monday (p < 0.001), and Thursday (p = 0.02) compared with Saturday by at least 1.09 times.   Lower numbers of cases around Christmas (3 days before and after; 22.0 vs. 32.3 on control dates, p < 0.001).	[5]
2012	Polish	The number of intoxication-related admissions proved to be significantly higher on Monday whereas significantly lower on Saturday. As far as the yearly seasonality is concerned the number of admissions to the Clinic was significantly below the average in February and in the period from August to October while it was significantly above the average in January and March.	[6]
2012 Apr	Iran	A remarkable peak in suicides was observed in May and July, while winter had the highest suicide rate among seasons.	[7]
2005 Jul	Nepal	Seasonal variation in poisoning was observed with more cases in the summer months.   Intensive care unit (ICU) service was required in 17% of patients; and almost 25% developed complications.   Ninety four percent of admitted patients recovered completely; leaving a mortality rate of 5%.	[8]
1997 Dec	State of Bahrain	A seasonal variation was noted with 46% of the cases occurring in the summer months.	[9]
1992 Apr	Bulgaria	Over the week, the smallest number was on Saturdays. There was a slight seasonal variation, with the highest number in March and the lowest in August.	[10]

 

References

[1] https://pubmed.ncbi.nlm.nih.gov/37632450/

[2] https://pubmed.ncbi.nlm.nih.gov/37226659/

[3] https://pubmed.ncbi.nlm.nih.gov/36843423/

[4] https://pubmed.ncbi.nlm.nih.gov/35619981/

[5] https://pubmed.ncbi.nlm.nih.gov/32141348/

[6] https://pubmed.ncbi.nlm.nih.gov/23243906/

[7] https://pubmed.ncbi.nlm.nih.gov/22424037/

[8] https://pubmed.ncbi.nlm.nih.gov/16554862/

[9] https://pubmed.ncbi.nlm.nih.gov/9519674/

[10] https://pubmed.ncbi.nlm.nih.gov/1571762/

 

 Edited by Yu-Jang Su Sep 24, 2023

 

Abamectin / emamectin/ Ivermectin Intoxication

  

Year	Country	Substance / Dose	Treatment / Outcome	Reference
2003	Taiwan	Oral application of ABM (20 mg/kg)	Concomitant epinephrine injection [100 micro-gm/ kg, subcutaneously (s.c.).	1
1999	Taiwan	Eighteen patients with abamectin (Agri-Mek; 2% wt/wt abamectin) exposure and 1 with ivermectin (Ivomec; 1% wt/vol ivermectin) ingestion.	Male: Female =14: 5 37% coma 37% admit to ICU 21% asymptomatic 16% hypotension 5% die of MOF.	2
2022	Taiwan	60 had ingested emamectin pesticides, and 4 had ingested abamectin.	Drowsiness (47%) Shortness of breath (SOB)/dyspnea (33%)  Nausea/vomiting (22%).  (27%) were intubated.     (31%) had severe outcomes. (78%) were admitted 42% required intensive care unit (ICU). 6.3% died   GCS score < 13 (OR 68.1, 95% CI 3.8-999) and the presence of SOB/dyspnea (OR 50.2, 95% CI 3.0-849.9) were associated with severe outcomes.	3
2015	People's Republic of China	Ingestion of a large dose of abamectin on purpose	Rapidly recovered consciousness after administration of flumazenil.	4
2004	Taiwan	Proclaim insecticide (Syngenta, Taiwan), consisting of 2.15% w/w emamectin benzoate in 2, 6-bis (1, 1-dimethylethyl)-4-methyl-phenol and 1-hexanol.	Transient gastrointestinal upset with endoscopy-proven gastric erosion and superficial gastritis, mild central nervous system depression, and aspiration pneumonia. Treated successfully with gastric lavage, administration of activated charcoal, and empiric antibiotics.	5
2007	Turkey	Toxic effects of abamectin are usually seen after abamectin oral ingestions.	Altered mental status, respiratory failure, and hypotension.	6
2016	China	acute avermectins poisoning	Nystagmus is rarely reported	7
2014	Iran	3600 mg abamectin orally.	Gastric lavage charcoal was administered. Altered mental status drowsiness, hypotension, tachycardia and dermal erythema. Treated as H1 and H2 blockers and vasoactive agents Altered mental status could be considered as the first sign of abamectin intoxication. Conservative treatment is recommended.	8
2020	People's Republic of China	400 mL of 5% abamectin pesticide.	Serious brain dysfunction and abnormal EEG caused by abamectin poisoning are treatable.  Despite poor clinical and EEG findings at the outset, recovery is still possible.	9

1.      https://pubmed.ncbi.nlm.nih.gov/12948083/

2.      https://pubmed.ncbi.nlm.nih.gov/10381994/

3.      https://pubmed.ncbi.nlm.nih.gov/35916769/

4.      https://pubmed.ncbi.nlm.nih.gov/26360693/

5.      https://pubmed.ncbi.nlm.nih.gov/15462160/

6.    https://pubmed.ncbi.nlm.nih.gov/17453886/

7.    https://pubmed.ncbi.nlm.nih.gov/24280654/

8.    https://pubmed.ncbi.nlm.nih.gov/25948975/

9.    https://pubmed.ncbi.nlm.nih.gov/33094704/

Edited by Yu-Jang Su   Aug 19, 2023

 

 

 

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 

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

 

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.