Andreas Schaper

Publications of Andreas Schaper

• Iatrogenic intravenous medication errors reported to the GIZ-Nord Poisons Center Göttingen.

  Authors: Michael Deters, Dagmar Prasa, Helmut Hentschel, Andreas Schaper

  European journal of internal medicine. 11/2009; 20(7):728-31.

  BACKGROUND: We analyzed the iatrogenic intravenous medication errors (IIME) reported to the GIZ-Nord Poisons Center Göttingen. METHODS: IIME over a ten year period were analyzed retrospectively andBACKGROUND: We analyzed the iatrogenic intravenous medication errors (IIME) reported to the GIZ-Nord Poisons Center Göttingen. METHODS: IIME over a ten year period were analyzed retrospectively and categorized into error types, age groups, drugs involved, and severity of IIME at registration and after known outcome. RESULTS: 265 IIME were registered from 1997 to 2006. They rose from 12 in 1997 to 45 in 2006 corresponding to an increase from 0.058 to 0.148% of all calls of the respective year. Children were affected in (21.1%) and adults in 78.9% of all cases. The drug classes (ATC classification) involved most frequently were antipsychotics (7.9%) and antithrombotic agents (6.0%). The main types of IIME were dosing error (37.7%) and wrong route of administration (28.7%). The severity of IIME at registration was none (33.6%), minor (32.5%), moderate (13.6%), severe (13.6%), fatal (1.5%), and unratable (5.2%). In the 46 cases followed to a known outcome, 15 were asymptomatic and 27 were symptomatic with minor (11 cases), moderate (5 cases) and severe features (11 cases). Four cases of IIME were already fatal at registration and one severe case died in the further course. Dosing error of theophylline was often observed in severe outcomes. CONCLUSION: IIME increased from 1997 to 2006. Intravenous use of antipsychotics and theophylline should be restricted to a minimum.

• Iatrogenic intravenous medication errors reported to the PIC Erfurt.

  Authors: Michael Deters, Dagmar Prasa, Helmut Hentschel, Andreas Schaper

  Clinical toxicology (Philadelphia, Pa.). 05/2008;

  Background. We investigated the iatrogenic intravenous medication errors (IIME) reported to the Poisons Information Center (PIC) Erfurt. Methods: All IIME over a ten year period were analyzedBackground. We investigated the iatrogenic intravenous medication errors (IIME) reported to the Poisons Information Center (PIC) Erfurt. Methods: All IIME over a ten year period were analyzed retrospectively and categorized into error types, age groups, drugs involved, and estimated risk of toxicity. Results. From 1997 to 2006 the PIC Erfurt registered 132 cases of IIME. They increased from 7 in 1997 to 31 in 2006. Children accounted for 31.1% of the patients affected and adults for 68.9%. The drug classes (ATC classification) involved most frequently were antipsychotics (9.8%) and antihistamines for systemic use (7.5%). The main types of IIME were overdose (53.1%) and incorrect route of administration (29.7%). The estimated risk of toxicity was: 14.4% none, 71.2% risk of toxicity, and 14.4% unpredictable risk. Medical treatment was recommended in 82%. The outcome of 104 of the 132 (78.8%) courses was unknown. In the 28 cases followed to a known outcome, 9 (32%) were asymptomatic and 19 (68%) symptomatic with minor (9 cases), moderate (1 case), and severe features (6 cases) but mostly complete recovery. Two IIME resulted in hypoxia-induced brain damage and one in death despite of resuscitation. Conclusion. Approximately 0.1% of all calls registered by the PIC Erfurt from 1997 to 2006 concerned IIME. Thirty-two percent of IIME followed to a known outcome resulted in severe symptoms. These data show that IIME can be harmful.

• Bites and stings by exotic pets in Europe: An 11 year analysis of 404 cases from Northeastern Germany and Southeastern France.

  Authors: Andreas Schaper, Herbert Desel, Martin Ebbecke, Luc de Haro, Michael Deters, Helmut Hentschel, Maren Hermanns-Clausen, Claus Langer

  Clinical toxicology (Philadelphia, Pa.). 05/2008;

  Introduction. The presence of exotic, and sometimes venomous, pets in European homes is becoming more common. This phenomenon is the basis of a French-German cooperative evaluation of the speciesIntroduction. The presence of exotic, and sometimes venomous, pets in European homes is becoming more common. This phenomenon is the basis of a French-German cooperative evaluation of the species causing the injuries and the circumstances, severity, and treatment of the envenomations Methods. A retrospective, descriptive, cross-sectional, case series of data from 1996 to 2006. The study sample consists of all cases of bites and stings by exotic pets that were registered at four poisons European poisons centers. The inclusion criteria were bites and stings of human beings. Results. From 1996 to 2006 four poisons centers in Europe were consulted on 404 bites and stings by exotic pets. The average age of the patients was 36 (2 to 75) years and 73% of the patients were male. The severity of the envenomations, according to the Poisoning Severity Score, was as follows: 29 severe (7.1%), 55 moderate (14.2%) and 320 minor (78.7%). There were no fatalities in this case series. Exotic snakebites from rattlesnakes, cobras, mambas, and other venomous snakes caused 39% of envenomations, aquatic animals (mostly lionfish of the Pterois genus and stingrays) caused 30% of envenomations and arthropods (tarantulas and scorpions) caused 27% of envenomations. All severe envenomations were caused by venomous snakes. Conclusions. European healthcare professionals may encounter patients bitten or stung by exotic pets. Poisons center consultation can help manage these unusual presentations and help obtain rarely used antivenoms.

• Surgical treatment in cocaine body packers and body pushers.

  Authors: Andreas Schaper, Rainer Hofmann, Philippe Bargain, Herbert Desel, Martin Ebbecke, Claus Langer

  International journal of colorectal disease. 01/2008; 22(12):1531-5.

  OBJECTIVE: Body packers smuggle cocaine by swallowing containers filled with the drugs, whilst body pushers conceal the containers in the rectum or vagina. In a collaborative effort between theOBJECTIVE: Body packers smuggle cocaine by swallowing containers filled with the drugs, whilst body pushers conceal the containers in the rectum or vagina. In a collaborative effort between the Department of General Surgery, two major airports and Poisons Centre, we performed a retrospective study to develop an algorithm for the treatment of ruptured cocaine-filled containers. MATERIALS AND METHODS: The data of all cocaine body packers and body pushers who were identified at the airports of Frankfurt and Paris from 1985 to 2002 were evaluated concerning incidence, demographics and surgical aspects. RESULTS: From 1985 to 2002, 312 body pushers and 4,660 body packers were identified. The sex ratio was 1:1. Sixty-four "mules" (1.4%) developed life-threatening symptoms of cocaine overdose after the rupture of a container. In 20 patients, an emergency laparotomy was performed and the containers were removed; all of these patients survived. Forty-four body packers died before surgical treatment could be performed. Only one body pusher required medical attention. CONCLUSION: Cocaine overdose can be life-threatening. If the cause is the rupture of a container in a body packer, the only possible treatment is immediate laparotomy for the removal of the container.

• Intoxication-related fatalities in northern Germany.

  Authors: Andreas Schaper, Babette Renneberg, Herbert Desel, Claus Langer

  European journal of internal medicine. 12/2006; 17(7):474-8.

  BACKGROUND: Knowing what substances cause death in intoxicated patients is of medical, legal, and political relevance. Harmonized data documentation like TESS (Toxic Exposure Surveillance System) inBACKGROUND: Knowing what substances cause death in intoxicated patients is of medical, legal, and political relevance. Harmonized data documentation like TESS (Toxic Exposure Surveillance System) in the United States does not exist yet in Germany. However, the GIZ-Nord Poison Center in Göttingen issues an annual report that includes fatalities. The aim of this study was to obtain an overview of the substances resulting in fatal poisoning and to define risk factors. METHODS: In a retrospective study, all fatalities due to poisoning from January 1996 until March 2003 were analyzed. RESULTS: From 1996 to 2003, the GIZ-Nord Poison Center was consulted in 168,000 cases. There were 142 fatalities due to poisoning (0.08% of all consultations). In 79 cases, the lethal substance was a medical drug, mostly tricyclic antidepressants and cardiovascular drugs. Two immigrants of German origin from the former Soviet Union died after consuming Amanita mushrooms. Five elderly, disorientated patients died of respiratory failure due to aspiration of detergent products from soap or shampoo. CONCLUSION: Three groups of patients with a high risk of dying from intoxication can be defined: (1) suicidal patients with access to tricyclic antidepressants or cardiovascular drugs, (2) immigrants from the former Soviet Union who mistake toxic German mushrooms for edible species, and (3) elderly, disorientated patients who ingest large amounts of soap or shampoo.

• Envenomation by Amazonian freshwater stingray Potamotrygon motoro: 2 cases reported in Europe.

  Authors: Ingrid Blanc-Brisset, Andreas Schaper, Philip Pommier, Luc de Haro

  Toxicon : official journal of the International Society on Toxinology. 02/2006; 47(1):32-4.

  Freshwater stingrays of the Potamotrygon genus are regarded by native people in the Amazonia as dangerous fishes responsible of frequent stings. Small freshwater stingrays are imported to Europe andFreshwater stingrays of the Potamotrygon genus are regarded by native people in the Amazonia as dangerous fishes responsible of frequent stings. Small freshwater stingrays are imported to Europe and sold as aquarium fish because they are easy to keep captive. The purpose of this report is to describe two new cases involving envenomation by freshwater stingray. One patient was an experienced 45-year-old French hobbyist. The second patient was a 35-year-old German pet store assistant. The clinical picture in both cases featured severe local pain with minimal systemic manifestations. Both patients recovered fully after symptomatic treatment. These two cases of envenomation call attention to the potential for injury among persons in close contact with venomous pets.

• Rattlesnake bites in Europe--experiences from southeastern France and northern Germany.

  Authors: Andreas Schaper, Luc de Haro, Herbert Desel, Martin Ebbecke, Claus Langer

  Journal of toxicology. Clinical toxicology. 02/2004; 42(5):635-41.

  INTRODUCTION: Rattlesnakes are indigenous to the New World and hence their envenomations are a significant percentage of all poisonings in North and South America. Some years ago rattlesnake bitesINTRODUCTION: Rattlesnakes are indigenous to the New World and hence their envenomations are a significant percentage of all poisonings in North and South America. Some years ago rattlesnake bites were virtually unknown in Europe. But the biodiversity of European household fauna has changed: cats and dogs are increasingly replaced by stingrays, tarantulas, fire fish, and rattlesnakes. This phenomenon is the background of a French-German cooperation to evaluate the relevance of rattlesnake bites for European doctors. MATERIAL AND METHODS: In a retrospective study all consultations of the GIZ-Nord poison centre in Göttingen and the Centre Antipoison in Marseille concerning bites of poisonous snakes in a 20-yr time period were analyzed. RESULTS: Altogether 671 cases of poisonous snake bites were registered. Rattlesnake bites came up to 21 (3.1% of all consultations due to poisonous snake bites). Over the years the number increased constantly. All patients were adult men with a mean age of 37.2 (20-64) years. There were no females and no pediatric patients involved. According to the Poisoning Severity Score there were 8 minor, 5 moderate, and 8 severe envenomations; no fatalities. The leading clinical symptoms consisted of rhabdomyolysis, neurological, and coagulational disorders. In 5 cases antivenom therapy was applied, and in 4 patients surgical therapy was performed. CONCLUSION: Rattlesnake bites are rare in Europe, but the incidence is rising. The patients' profile is different from large American case series. European doctors should be aware of the increase in these infrequent envenomations.

• Iatrogenic intravenous medication errors reported to the GIZ-Nord Poisons Center Göttingen

  Authors: Michael Deters, Dagmar Prasa, Helmut Hentschel, Andreas Schaper

  European Journal of Internal Medicine.

  BackgroundWe analyzed the iatrogenic intravenous medication errors (IIME) reported to the GIZ-Nord Poisons Center Göttingen.MethodsIIME over a ten year period were analyzed retrospectively andBackgroundWe analyzed the iatrogenic intravenous medication errors (IIME) reported to the GIZ-Nord Poisons Center Göttingen.MethodsIIME over a ten year period were analyzed retrospectively and categorized into error types, age groups, drugs involved, and severity of IIME at registration and after known outcome.Results265 IIME were registered from 1997 to 2006. They rose from 12 in 1997 to 45 in 2006 corresponding to an increase from 0.058 to 0.148% of all calls of the respective year. Children were affected in (21.1%) and adults in 78.9% of all cases. The drug classes (ATC classification) involved most frequently were antipsychotics (7.9%) and antithrombotic agents (6.0%). The main types of IIME were dosing error (37.7%) and wrong route of administration (28.7%). The severity of IIME at registration was none (33.6%), minor (32.5%), moderate (13.6%), severe (13.6%), fatal (1.5%), and unratable (5.2%). In the 46 cases followed to a known outcome, 15 were asymptomatic and 27 were symptomatic with minor (11 cases), moderate (5 cases) and severe features (11 cases). Four cases of IIME were already fatal at registration and one severe case died in the further course. Dosing error of theophylline was often observed in severe outcomes.ConclusionIIME increased from 1997 to 2006. Intravenous use of antipsychotics and theophylline should be restricted to a minimum.