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ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 2  |  Page : 223-226

Retrospective evaluation of patients at follow-up with acute poisoning in Intensive Care Unit


1 Department of Internal Medicine, Fındıklı State Hospital, Rize, Turkey
2 Department of Internal Medicine, Taslıçay State Hospital, Ağrı, Turkey
3 Department of Internal Medicine, Malatya State Hospital, Malatya, Turkey
4 Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey

Date of Acceptance26-May-2015
Date of Web Publication9-Feb-2016

Correspondence Address:
Dr. S Yaylaci
Department of Internal Medicine, Fındıklı State Hospital, Rize
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.164340

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   Abstract 

Objective: Poisonings are among the major causes of emergency visits and intensive care hospitalizations. The aim of our study is to evaluate intoxicated patients at follow-up and treated in the Intensive Care Unit (ICU) in terms of demographic characteristics, type of poisonings and results of treatment.
Materials and Methods: Patients at follow-up aged 17 or older admitted with intoxication to the ICU between January 1, 2009 and December 31, 2011 were included in the study. Age, gender, presenting symptoms, duration of hospitalization, type of poisoning, the way of poisoning, medical history, seasons, hospitalization costs, treatment and prognosis of the patients were analyzed.
Results: Totally, 153 (8.9%) out of 1375 follow-up patients in the ICU had acute intoxication. The mean age of intoxicated patients was 29.4 ± 11, 68% of them were female, 78.4% of them were under 35 years old, and intoxication was most common in the 17–25 age group. 114 of them (94.1%) were suicidal. The most common cause of poisoning was drug-poisoning by 88.2%, and most common presenting symptoms were nausea and vomiting by 71.2%. Mean length of stay was 2.4 ± 1.6 days, and the average cost of hospitalization was 761 ± 884 Turkish Liras or 271 ± 315 USD. 5 patients (3.3%) were intubated because of respiratory failure. There was no mortal case.
Conclusion: Suicide attempts are prominent in acute poisoning, and the young female population is at higher risk. It was found that drugs, particularly antidepressants and antipsychotic agents were the most common cause of poisoning. The high cost of treatment of acute intoxication cases is a major cause of economic burden. Clinicians should be more careful when prescribing such drugs.

Keywords: Cost, intensive care, intoxication, prognosis


How to cite this article:
Yaylaci S, Genç A B, Demir M V, Cinemre H, Tamer A. Retrospective evaluation of patients at follow-up with acute poisoning in Intensive Care Unit. Niger J Clin Pract 2016;19:223-6

How to cite this URL:
Yaylaci S, Genç A B, Demir M V, Cinemre H, Tamer A. Retrospective evaluation of patients at follow-up with acute poisoning in Intensive Care Unit. Niger J Clin Pract [serial online] 2016 [cited 2019 Sep 21];19:223-6. Available from: http://www.njcponline.com/text.asp?2016/19/2/223/164340


   Introduction Top


Acute poisonings are a major health and socioeconomic problem in societies. It was found that 0.7–2.4% of emergency visits were poisoning cases.[1],[2] 4.1–30.8% of cases of acute poisoning are followed up in Intensive Care Units (ICUs).[3],[4],[5],[6] Intoxicated patients admitted to the emergency department of Sakarya Training and Research Hospital. They were evaluated against the poisoning agent and clinical and laboratory findings of the patient. Patients are referred to ICU if there is a life-threatening situation. In our study, we aimed to investigate retrospectively the age, gender, presenting symptoms, duration of hospitalization, type of poisoning, the way of poisoning, medical history, seasons, hospitalization costs, treatment, and prognosis of the patients admitted to ICU due to acute intoxication in this period of 3 years.


   Materials and Methods Top


Patients at follow-up aged 17 or older admitted with intoxication to the ICU of Sakarya Training and Research Hospital between January 1, 2009 and December 31, 2011 were included in our study. Patients with changes in consciousness, arrhythmia, and respiratory distress were followed up in the ICU in accordance with the recommendations of the poison control center regarding the signs and symptoms of the patients. The parameters of the patients such as age, gender, presenting symptoms, duration of hospitalization, type of poisoning (drugs, foods and mushrooms, alcohol, rat poisons and pesticides, toxic gases), the way of poisoning (suicides, accidents), medical history (psychiatric illness, suicide attempts), seasons, hospitalization costs, treatment, and prognosis (healing, rejection of treatment, referral, exitus) were screened retrospectively and recorded. Statistical analyses were performed using SPSS 17.0 software (SPSS Inc., Chicago, IL). Quantitative variables were expressed as arithmetical mean ± standard deviation and qualitative variables were expressed as percentages.


   Results Top


Totally, 153 (8.9%) out of 1375 follow-up patients in the ICU had acute intoxication. The mean age of 153 intoxicated patients was 29.4 ± 11, 68% of them were female, and 78.4% of them were under 35 years old. 144 (94.1%) were suicide attempts, 9 (5.9%) were diagnosed as poisoning due to accidents/exposure and admitted to the ICU. The most common cause of poisoning was drug-poisoning by 88.2%, and it was found that taking multiple drugs (34.8%) and antidepressant-antipsychotic drugs (34%) were the most common in drug-poisoning. The most common presenting symptom was nausea and vomiting by 71.2%. Poisoning was more frequent (%33.3) in winter. There were 9.2% psychiatric illness and 2% suicide attempts in the histories of patients. 3.3% of patients were intubated because of respiratory failure. Mean length of stay was 2.4 ± 1.6 days, and the average cost of hospitalization was 761 ± 884 Turkish Liras or 271 ± 315 USD. In addition to intravenous fluid treatments, all patients were treated with gastric lavage and activated carbon. 10 (6.5%) patients were treated with N-acetylcysteine due to poisoning with toxic doses of paracetamol, 1 (0.6%) patient was treated with hemodialysis due to intoxication with toxic doses of carbamazepine. There were no mortal or referral cases. Findings are summarized in [Table 1].
Table 1: Demographic and prognostic characteristics of the patients

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   Discussion Top


For all patients admitted to the ICU due to acute intoxication, airway patency was provided, intravenous access was opened, vital data were monitored, neurological and systemic examination were performed and poisoning control center was informed. Acute intoxication is a major health and socioeconomic problem since it causes morbidity and mortality and increases spending on health. Early diagnosis and treatment should be carried out due to the risk of morbidity and mortality in case of clinically suspected acute intoxication. For this, it is necessary to know the etiology and demographic characteristics.

The ratio of patients who were followed in intensive care due to poisoning was found as 4.1–30.8% in Turkey,[3],[4],[7] whereas this ratio was 2.3–9.3% in the literature.[5],[8] In our study, 8.9% of follow-up patients in the ICU had acute intoxication.

It was found that 78–92% of the poisoning cases followed up in the ICU were caused by a suicide attempt.[5],[7],[9] In our study, it was determined that of the patients admitted to the ICU due to poisoning, 144 (94.1%) were suicide attempts, and 9 (5.9%) were poisoning due to accidents/exposure, consistent with the literature.

Looking at the demographic data of the studies conducted in Turkey, female gender ratio was 71.2–82%, ratio of patients aged 35 or younger was 72.1–82%, and the ratio of a history of psychiatric illness was found as 15.7–42%.[3],[9],[10] Looking at the demographic data of the studies worldwide, female gender ratio was 49.3–69.2%, ratio of patients aged 40 or younger was 75%.[5],[11] In our study, female gender ratio of 68% and the 78.4% ratio of patients aged 35 or younger was consistent with the studies. There were 9.2% psychiatric illness and 2% suicide attempts in the histories of patients. The importance of the issue is increased further due to the fact that majority of patients are young and healthy.

Among the causes of intoxication in studies conducted in Turkey, ratio of combined drug intoxication was 28.6–48%, the ratio of antidepressant-antipsychotic drugs was 20.6–23.8% and the ratio of analgesics was 5.6–56%.[3],[7],[9] Among the causes of intoxication in studies conducted worldwide, the ratio of combined drug was 17.9%, the ratio of antidepressant-antipsychotic drugs was 5–25%, the ratio of analgesics was 7.8–21%, and the ratio of pesticides was 39.5%.[8],[11] In our study, drug-poisoning was found in 88.2% of the patients. The drug intoxications 34.8% was combined drugs, 34% was antidepressants and antipsychotics, and 14.8% was analgesics. Furthermore, antidepressant drugs were more common in the group that takes multiple drugs. These ratios are consistent with the literature.

Mean length of stay was 2.48 ± 2.78 days in a study.[7] In our study, the mean length of stay was determined as 2.4 ± 1.6 days. Although overall mortality of acute poisoning cases is low, mortality is high in acute pesticide-poisoning and aluminum phosphide poisoning.[5] Mechanical ventilation was reported as 2.6–5.3%.[9],[10] The mortality rate in Turkey was determined as 0.1–2.9%[9],[10],[11] and it was found as 2.8–27%[8],[12],[13] worldwide. There was no mortality in our study and mechanical ventilation was necessary only in 5 patients (3.3%) due to respiratory failure. The reason for the lack of mortality in our study was attributed to the low ratio of pesticide-poisoning observed, which has a higher mortality rate.

In studies, the cost of hospitalization was determined as 405 ± 241 Turkish Liras and 144 ± 90 USD.[14],[15] In our study, the average hospitalization cost was determined as 761 ± 884 Turkish Liras or 271 ± 315 USD. This higher cost was attributed to the follow-up of patients in the ICU.


   Conclusion Top


Suicide attempts are prominent in acute poisoning, and the young female population is at higher risk. It was found that drugs, particularly antidepressants and antipsychotic agents were the most common cause of poisoning. The high cost of treatment of acute intoxication cases is a major cause of economic burden. Clinicians should be more careful when prescribing such drugs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Ozköse Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol 1999;18:614-8.  Back to cited text no. 1
    
2.
Akbaba M, Nazlican E, Demirhindi H, Sütoluk Z, Gökel Y. Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey. Hum Exp Toxicol 2007;26:401-6.  Back to cited text no. 2
    
3.
Kıyan S, Özsaraç M, Ersel M, Yuruktumen A, Karahallı E, Ozcete E, et al. Analysis of patients with acute intoxication in a two year period. Turk J Emerg Med 2009;9:24-30.  Back to cited text no. 3
    
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Kurt I, Erpek AG, Kurt MN, Gürel A. Epidemiology of adult poisoning at Adnan Menderes University. Journal Of Adnan Menderes University Medical Faculty 2004;5:37-40.  Back to cited text no. 4
    
5.
Singh O, Javeri Y, Juneja D, Gupta M, Singh G, Dang R. Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India. Indian J Anaesth 2011;55:370-4.  Back to cited text no. 5
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Erkuran MK, Duran A, Ocak T, Citisli V, Kaya H. The impact of the duration of admission to the emergency room on the mortality of intensive care patients. Niger J Clin Pract 2014;17:320-3.  Back to cited text no. 6
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Doğan S, Can H, Gönüllü M, Alaygut E, Turan M. Evaluatıon of patıents wıth poısonıng whose treatment was made ın anaesthesıa ıntensıve care unıt. The Journal of Tepecik Education and Research Hospital 2010;20:25-8.  Back to cited text no. 7
    
8.
Viertel A, Weidmann E, Brodt HR. Cases of acute poisoning admitted to a medical intensive care unit. Dtsch Med Wochenschr 2001;126:1159-63.  Back to cited text no. 8
    
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Demirel İ. A retrospective analysis of intoxication cases in intensive care unit of Elazığ Education and Research Hospital. Firat Med J 2010;15:184-7.  Back to cited text no. 9
    
10.
Kaygusuz K, Gürsoy S, Kılıçcıoğlu F, Özdemirkol İ, Mimaroğlu C. The retrospective analysis of the cases that were observed with the diagnosis of acute drug intoxication in the intensive care unit of Cumhuriyet University Medical Faculty Hospital between 1998-2004 years. Cumhuriyet Medical Journal 2004;26:161-5.  Back to cited text no. 10
    
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Uyanıkoğlu A, Zeybek E, Cordan İ, Avcı S, Tükek T. Evalution of intoxication cases. Nobel Med 2007;3:18-22.  Back to cited text no. 11
    
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Jesslin J, Adepu R, Churi S. Assessment of prevalence and mortality incidences due to poisoning in a South Indian tertiary care teaching hospital. Indian J Pharm Sci 2010;72:587-91.  Back to cited text no. 12
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Juárez-Aragón G, Castañón-González JA, Pérez-Morales AJ, Montoya Cabrera MA. Clinical and epidemiological characteristics of severe poisoning in an adult population admitted to an intensive care unit. Gac Med Mex 1999;135:669-75.  Back to cited text no. 13
    
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Akar T, Derinöz O, Demirel B. Drug intoxications and hospital costs. Turk Arch Ped 2007;42:103-6.  Back to cited text no. 14
    
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Serinken M, Karcioglu O, Sengul C, Turkcuer I, Keysan MK. Hospital costs of managing deliberate self-poisoning in Turkey. Med Sci Monit 2008;14:CR152-8.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1]


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