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Poisoning in Elderly
Abstract
Poisoning constitutes a major cause of emergency department visits globally. With an increase in new household chemical supplies, cleaning agents and disinfectants, pesticides and fertilizers, drugs and pharmaceuticals, the cases of poisonings are being increasingly encountered. Although elderly patients account for a small fraction of total poison exposures, but, when exposed they have a high risk for mortality because of existing co-morbidities and age-related physiological changes in renal and hepatic functions. Thus, elderly people represent a special group in the context of poisoning. Judicious use of medications like avoidance of polypharmacy and appropriate dosage of the prescribed drugs due to narrow therapeutic range are effective ways to prevent poisoning (especially unintentional/accidental situations) in the elderly. Collecting detailed epidemiological information on poisoning exposures in the country and formulating strategies to reduce poisoning exposures is the need of the hour.
... On the other hand, elderly individuals who experience poisoning are more susceptible to severe health outcomes and higher mortality rates compared to younger individuals (Haselberger & Kroner, 1995). Hence, poisoning in the elderly demographic is viewed as a significant health concern that poses a substantial burden of illness, potentially leading to increased healthcare expenses (Barman et al., 2018;Rietjens et al., 2022). ...
... Additionally, SUD is common among the elderly, who may use substances for different purposes, including self-medication, euphoria, etc., such as opioids for relieving musculoskeletal pain (Dufort & Samaan, 2021;Kuerbis, 2020;Seim et al., 2020). Various socioeconomic and risk factors directly or indirectly influence the common causes and manners of intoxication in older adults (Barman et al., 2018;Laflamme et al., 2024;Rietjens et al., 2022). Understanding these risk factors and patterns of intoxication can provide valuable insights into poisoning among the elderly. ...
... The pattern and risk factors of elderly poisoning may be diverse in various nations, for instance, poisoning among the elderly in Spain vs. India (Barman et al., 2018;Miranda Arto et al., 2014). Previous studies revealed that the pattern of intoxication can also change through the time (Alizadeh et al., 2017;Banaye Yazdipour et al., 2022;Ferrando et al., 2021;Lawrence et al., 2023). ...
This study aimed to assess the risk factors and clinical-epidemiological patterns of acute poisoning among elderly individuals to guide prevention strategies. The epidemiological, clinical data, manner and cause of poisoning, and outcome of the registered elder cases (≥ 60 years old) in the clinical toxicology department of Imam Reza Hospital of Mashhad University of Medical Silences (CTD-IRH-MUMS) were investigated for nine months. The sex and age distribution of the patients were compared with the general population of Khorasan-Razavi using direct standardization. Among the 3064 cases registered at the hospital, 124 elderly patients were included in the study. The majority (71.8%) were male, with a mean age of 69.47. Male gender was found to be a significant risk factor for poisoning among elderly individuals compared to the general population (OR = 2.62) (1.55–4.42) (p-value < 0.001), however, it was not significant for age. Substance dependency, particularly on opiates, was common among the patients (56.5%), with a higher prevalence in males. Substance overdose (35.4%) and suicide (23.3%) were the most common methods of poisoning, with varying frequencies between genders (p-value = 0.002). Male gender was identified as a risk factor for opiate intoxication (OR = 4.68, CI = 1.70-11.83, p-value < 0.05) but not for suicide attempts. The average hospital stay duration was similar between male and female patients. The mean length of hospital stay was 3.53 ± 4.02 days (median = 3.0, range = 0.5–26 days) and was similar in both sexes. In conclusion, male gender and opiate dependency were highlighted as key factors in the poisoning of elderly individuals. These findings emphasize the importance of addressing these factors in preventive measures.
... Older people poisoning rises concerns also because of its severity as demonstrated by mortality [6][7][8] and morbidity [9][10] studies showing that poisoning generally has poorer clinical outcomes among them than it does among their younger adult peers. Poisoning is also known as the most common method of deliberate self-harm and suicide among older adults [3,6,10], with drugs being the most common poisoning agent [1,[5][6][7][8], [11][12][13], something that likely reflects a greater access to drugs and elevated risks of improper drug use or adverse drug reaction [14]. Further, while older people are less prone to deliberate-self harm, there is a greater degree of intent and lethality in the act they pose [7,10,15], which most often is a selfpoisoning. ...
... Owing to the facts that older people who self-harm is at very high risk of either repeated self-harm or suicide [17] and that poisoning is, among them, the most common form of incidental and repeated self-harm, self-poisoning in this population group deserves particular clinical and public health attention [7]. Medical professionals certainly have a key role to play in the recognition of groups at risk of self-harm and self-poisoning repetition, fatal or not [14]. ...
Background
Poisoning injuries is an increasing concern among older people, and so is the repetition of intentional poisonings. To date, few studies have documented the pattern and individual risk factors for repeated poisonings. This national study aims to shed light on the burden, pattern, and health-related risk factors of repeated intentional poisoning leading to hospitalization or death among older Swedish adults (50 years and older), with a focus on the year following a first event.
Methods
We conducted a nationwide register-based cohort study of people aged 50–100, hospitalized for intentional poisoning (ICD10: X60-69) during 2006–2016 (n = 15,219) and re-hospitalized by poisoning of any intent within a year (n = 1710), i.e., up to the end of 2017. We considered in turn, the distribution of the second poisoning in 30-day intervals stratified by intent; poisoning lethality within a month and a year; and the sex-specific association between health conditions and being re-hospitalized for intentional poisoning within one year as compared to being hospitalized only once using logistic regression (odds ratios (OR) with 95% confidence intervals (95% CI)).
Results
Following an intentional poisoning, re-hospitalization within a year was predominantly for a new intentional poisoning (89.7%) and occurred most typically within a month (median 4 days). Death within 30 days occurred in similar proportion for the first and second poisoning (2.3% vs. 2.1% respectively). Among both men and women, comorbidity of psychiatric illness was strongly associated with re-hospitalization for intentional poisoning (adjusted ORs = 1.70; 95% CI = 1.45–2.01 and 1.89 (95% CI = 1.60–2.19) respectively).
Conclusion
Most re-hospitalizations within a year after intentional poisoning are also for intentional poisoning and occur most typically within days. Re-hospitalization is associated with several conditions that are characteristic of poor mental health and there are more similarities than differences between men and women in that respect.
... In the current study, the patient age was included in 13 nomograms as the second most applied predictor following GCS. Age is one of the demographic data with a well-established influence on poisoning severity; as extreme age, either pediatric or old patients are more liable to poor outcomes (Barman et al. 2018;Sayed et al. 2024). Subsequently, nomograms included age as one of the predictors of serious arrhythmia in acute digoxin poisoning (El Gameel et al. 2023), in addition to assessing the severity of organophosphorus poisoning (Dong et al. 2021). ...
Nomograms represent powerful predictive tools that could be easily applied to guide managing acutely intoxicated patients. Thus, several nomograms were developed and validated in the last few decades to predict various outcomes following acute poisoning. However, the adopted nomograms remain sporadic efforts of researchers that limited their usefulness in clinical settings. We aimed to bridge the gap between theoretical formulation and hands-on application of the developed nomograms to benefit acutely poisoned patients. In this context, this systematic review was conducted to be a reference guide for implementing these nomograms in clinical toxicology practice. This review included 27 studies that were published over 60 years. A total of 60,883 patients ranging between 2 and 91 years were enrolled. These studies elaborated 38 nomograms; 13 nomograms addressed acute poisoning in general, and 25 nomograms were specially designed for six poisons/categories, including pesticides (n = 9), psychotropic drugs (n = 5), alcohol (n = 4), analgesics, and anti-inflammatory medications (n = 3), carbon monoxide (n = 2), and digoxin (n = 2). Despite the first nomogram was published in 1960, 81.5% of nomograms emerged after 2016, with a significant increase in the trend of published nomograms (p < .001). The Glasgow Coma Scale, patient age, poison concentration, bicarbonate level, and blood pressure were the most frequently used predictors. The nomograms were designed to predict eight outcomes, including mortality (n = 14, 36.8%), need for intensive care unit (ICU) admission (n = 9, 23.7%), complications of poisoning (n = 6, 15.8%), optimization of therapy (n = 4, 10.5%), and poisoning severity (n = 2, 5.3%). Also, the need for mechanical ventilation (MV), diagnosis of poisoning, and suicidal poisoning were predicted by one nomogram for each of them. The developed nomograms' performances were tested using receiver operating characteristic analysis and the area under a curve of 26 derived nomograms ranged between 0.839 and 0.999. External validation was conducted on 16 nomograms only; 15 nomograms were validated using validation cohorts within the same studies that developed the nomograms. However, only one nomogram was subjected to external validation by other studies. The externally validated nomograms consist of 10 nomograms for managing particular poisoning and, six nomograms for un-specified poisoning. The poison-specific nomograms were concerned with acute poisoning with pesticides (n = 4), methanol (n = 2), opioid (n = 1), clozapine (n = 1), carbon monoxide (n = 1), and digoxin (n = 1). Regarding six validated nomograms in a general poisoning approach, two nomograms predicted mortality. Nevertheless, four separate nomograms were concerned with the prediction of poisoning complications, the need for ICU admission, the need for MV, and suicidal poisoning. The external validation of the established nomograms ensured their performance and reliability for universal applicability in clinical settings. Meanwhile, the remaining 22 nomograms lacking external validation represent promising research opportunities.
... In the absence of specific antidote, treatment of acute antipsychotics overdose depends mainly on supportive treatment determined by the clinical condition of the patient. It includes care of the airway and breathing support, cardiac monitoring, intravenous (IV) fluids, in addition to gastrointestinal decontamination to prevent further absorption (Barman, et al., 2018). A Intravenous lipid emulsion (ILE) is originally developed to supply patients requiring parenteral nutrition with essential fatty acids (ok et al., 2018). ...
Background: Antipsychotics toxicity is one of the top five substances most frequently included in human poisoning. Various case reports documented successful use of intravenous lipid emulsion (ILE) in the management of acute antipsychotics poisoning. Aim: The aim of this study was to assess the efficacy and safety of ILE as adjuvant therapy for acute antipsychotic poisoning. Patients and methods: Forty patients presented with moderate to severe acute antipsychotic poisoning were randomly allocated into two equal groups. The control group was given the standard treatment only while the intervention group was given the standard treatment plus ILE infusion. For all patients, history, clinical examination, ECG, and laboratory investigations were done. The safety and efficacy outcomes were evaluated. Results: results revealed that the median Glasgow Coma Scale assessed at 6 and 12 hours after admission was significantly higher in the intervention group compared to the control group. Both corrected QT intervals measured 12 hours after admission and period of hospital stay were significantly shorter in the intervention group compared to the control group. During follow-up of the intervention group, there were no significant differences between serum triglycerides levels, liver enzymes and, platelet count measured at admission and 12 hours later. Conclusion: It was concluded that ILE was a safe and effective therapy for acute antipsychotic poisoning.
... 3 Elderly patients have slower break down of alcohol due to the decreased enzyme activity (ADH, reduced Acute severe poisoning with disinfectant in senior aged patient-case report and overview of literature considering age influence on treatment decision in alcohol-based intoxications availability of NAD+ and cytochrome P-450 system with CYP 1-3 family), 4 decreased volume of distribution, and renal function and polypharmacy treatment which contribute to the development of more severe poisonings. 5 We present the decision-making process and clinical course of the first severe suicidal poisoning with 70% ethanol-disinfectant in North Macedonia, in an elderly immunocompromised patient. ...
We present our experiences in the first case of severe suicidal poisoning with 70% ethanol-disinfectant in North Macedonia, in an elderly patient with immunocompromising comorbidities. A 66-year-old unconscious woman was admitted at our clinic, with a history of seropositive rheumatoid arthritis treated with methotrexate. She was in a coma, without signs of serotonin syndrome, recurrent episodes of cardio-respiratory insufficiency under supportive treatment without invasive ventilation, metabolic acidosis, increased D-dimer 3254 ng/mL. The toxicology screening confirmed low benzodiazepines levels and alcoholaemia of 526 mg/dL (5.26 g/L), due to ingestion of 70% ethanol. Considering the decreased biotransformation in the elderly, immunocompromising comorbidities, reports of fatal outcome in poisoned elderly patients with disinfectants under standard fluids supportive protocol, haemodialysis was initiated, with registered associated hypercoagulability which resulted in complete stabilization after 48 h of admission. Treatment protocols of poisoning with ethanol-based disinfectant in the elderly should consider timely performing haemodialysis at lower alcoholaemia levels than recommended.
Purpose : This study aimed to determine the mortality rate among elderly patients admitted to the intensive care unit (ICU) for acute drug intoxication resulting from suicide attempts. It also compared the characteristics of survivors and decedents to identify factors associated with mortality.Methods : This retrospective descriptive study included 150 patients aged 65 years or older who were admitted to the ICU of a tertiary university hospital in Gwangju due to acute drug intoxication, with the period spanning January 1, 2018 to December 31, 2020. The collected data were analyzed using descriptive statistics, independent t-tests, Chi-squared tests, Fisher's exact test, and multiple logistic regression analysis.Results : The mortality rate among elderly individuals admitted to the ICU for acute drug intoxication was 19.3%. The likelihood of death was significantly higher in patients with an acute physiology and chronic health examination (APACHE) Ⅲ score of 70 or above (OR=23.75, 95% CI=3.78-149.46, p ＜.001) and those with metabolic acidosis on initial acid-base results (OR=3.73, 95% CI=1.12- 12.43, p =.032).Conclusion : These findings underscore the need for developing and implementing systematic education and targeted nursing interventions for ICU nurses caring for acutely drug-intoxicated elderly adults, particularly considering the APACHE Ⅲ score and the presence of metabolic acidosis.
Objective:
Intoxications in the pediatric population account for a signicant portion of the causes of care in emergency services, but they are also fatal in many cases in our country.
Methods:
Exposure to a toxic or poison and its adverse effects can become medical emergencies of great magnitude, which is why many authors consider them "multiple traumas of chemical origin." This is why the management of an intoxicated pediatric patient has a unique approach due to the diagnostic challenge that it represents.
Results:
Timely and systematized care of a pediatric patient in the context of poisoning can represent the success of timely care, correct assessment, and an adequate care process.
Conclusions:
The objective of this work is to present a general approach for the intoxicated pediatric patient regarding the initial management, the approach, and the clinical data that can guide us in the emergency department when faced with an intoxicated pediatric patient.
Elderly patients with atrial fibrillation are at a higher risk of both ischemic and bleeding events compared with younger patients; therefore, balancing risks and benefits of antithrombotic strategies in this population is crucial. Recent studies have shown that because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation is the highest in elderly patients in whom it outweighs the risk of bleeding. Direct oral anticoagulants (DOACs) have been developed as a treatment for the prevention of cardioembolic stroke to overcome some limitations of warfarin, such as the need for frequent monitoring, labile INR values requiring frequent dose adjustment, dietary and drugs interactions, and increased risk of intracranial bleeding. Despite the better safety profiles of DOACs compared with warfarin, elderly patients often remain undertreated because of the fear of bleeding complications. This review summarizes current evidence regarding the risks of thromboembolisms and bleeding in different antithrombotic strategies in elderly patients (aged ≥75 years) with atrial fibrillation, including data from the warfarin-controlled phase 3 DOACs trials.
To investigate the association between antidepressant treatment and risk of several potential adverse outcomes in older people with depression and to examine risks by class of antidepressant, duration of use, and dose.
Cohort study of people aged 65 and over diagnosed as having depression.
570 general practices in the United Kingdom supplying data to the QResearch primary care database.
60,746 patients diagnosed as having a new episode of depression between the ages of 65 and 100 years from 1 January 1996 to 31 December 2007 and followed up until 31 December 2008.
Hazard ratios associated with antidepressant use for all cause mortality, attempted suicide/self harm, myocardial infarction, stroke/transient ischaemic attack, falls, fractures, upper gastrointestinal bleeding, epilepsy/seizures, road traffic accidents, adverse drug reactions, and hyponatraemia, adjusted for a range of potential confounding variables. Hazard ratios were calculated for antidepressant class (tricyclic and related antidepressants, selective serotonin reuptake inhibitors, other antidepressants), dose, and duration of use and for commonly prescribed individual drugs.
54,038 (89.0%) patients received at least one prescription for an antidepressant during follow-up. A total of 1,398,359 antidepressant prescriptions were issued: 764,659 (54.7%) for selective serotonin reuptake inhibitors, 442,192 (31.6%) for tricyclic antidepressants, 2203 (0.2%) for monoamine oxidase inhibitors, and 189,305 (13.5%) for the group of other antidepressants. The associations with the adverse outcomes differed significantly between the antidepressant classes for seven outcomes. Selective serotonin reuptake inhibitors were associated with the highest adjusted hazard ratios for falls (1.66, 95% confidence interval 1.58 to 1.73) and hyponatraemia (1.52, 1.33 to 1.75) compared with when antidepressants were not being used. The group of other antidepressants was associated with the highest adjusted hazard ratios for all cause mortality (1.66, 1.56 to 1.77), attempted suicide/self harm (5.16, 3.90 to 6.83), stroke/transient ischaemic attack (1.37, 1.22 to 1.55), fracture (1.64, 1.46 to 1.84), and epilepsy/seizures (2.24, 1.60 to 3.15), compared with when antidepressants were not being used. Tricyclic antidepressants did not have the highest hazard ratio for any of the outcomes. Significantly different associations also existed between the individual drugs for the same seven outcomes; trazodone (tricyclic antidepressant), mirtazapine, and venlafaxine (both in the group of other antidepressants) were associated with the highest rates for some of these outcomes. Absolute risks over 1 year for all cause mortality were 7.04% for patients while not taking antidepressants, 8.12% for those taking tricyclic antidepressants, 10.61% for selective serotonin reuptake inhibitors, and 11.43% for other antidepressants.
Selective serotonin reuptake inhibitors and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with tricyclic antidepressants. Among individual drugs, trazodone, mirtazapine, and venlafaxine were associated with the highest risks for some outcomes. As this is an observational study, it is susceptible to confounding by indication, channelling bias, and residual confounding, so differences in characteristics between patients prescribed different antidepressant drugs that could account for some of the associations between the drugs and the adverse outcomes may remain. Further research is needed to confirm these findings, but the risks and benefits of different antidepressants should be carefully evaluated when these drugs are prescribed to older people.
Management of anticoagulation in elderly patients represents a particularly challenging issue. Indeed, this patient population is at high thromboembolic risk, but also at high hemorrhagic risk. Assessment of the benefit-risk balance of anticoagulation is the key point when decisions are made about introducing and/or continuing such treatments in the individual elderly patient. In order to maximise the safety of anticoagulation in the elderly, some specific considerations need to be taken into account, including renal insufficiency, modified pharmacodynamics of anticoagulants, especially vitamin K antagonists, and the presence of multiple comorbidities and concomitant medications. New anticoagulants could greatly simplify and possibly increase the safety of anticoagulation in the elderly in the near future.
Adult salicylate intoxication has been considered to be easily recognized and assciated with low morbidity and mortality. In the present study of 73 consecutive adults hospitalized with salicylate intoxication, 27% of patients were undiagnosed for as long as 72 h after admission. The initial physical findings and laboratory data in patients not diagnosed on admission did not markedly differ from the findings in patients diagnosed on admission, and included tachypnea and acid-based disturbances as well as the frequent occurrence of neurologic abnormalities. However, patients with a delayed diagnosis of salicylate intoxication were older, rarely had a previous history of drug overdose, and more often became accidentally intoxicated while ingesting salicylate for associated medical illnesses when compared with patients diagnosed on admission. Moratlity was encountered with significantly greater frequency in patients with delayed diagnosis, and, consequently, delayed therapy, when compared with patients diagnosed on admission.
To compare the toxicity of beta blockers in overdose and to identify clinical features predictive of serious toxicity.
Comparison of clinical data collected prospectively on a relational database of subjects presenting to hospital with self-poisoning, coroner's data and prescription data.
Newcastle and Lake Macquarie, Australia, 1987-1995.
Death, seizure, cardiovascular collapse, hypoglycemia, coma and respiratory depression.
Fifty-eight self-poisonings with beta blockers and two deaths investigated by the coroner with evidence of propranolol poisoning.
All patients who developed toxicity did so within six hours of ingestion. The use of ipecac was temporally associated with cardiorespiratory arrest in one patient. Propranolol was the only beta blocker associated with seizure; of those who ingested more than 2 g of propranolol, two thirds had a seizure. There was a significant association between a QRS duration of > 100 ms and risk of seizures. Propranolol was over represented in beta blocker poisoning when prescription data were also examined. Propranolol was the only beta blocker associated with death. Propranolol was taken by a younger age group.
Propranolol should be avoided in patients at risk of self-poisoning. Propranolol poisonings should be observed closely for the first six hours post ingestion. Syrup of ipecac should not be used to decontaminate the gastrointestinal tract after beta blocker overdose.
A retrospective analysis of poisoning calls received by the National Poisons Information Centre showed a total of 2719 calls over a period of three years (April 1999-March 2002). The queries were made on poisoning management (92%) and information (8%) about various products and functioning of the centre. The data were analysed with respect to age, sex, mode and type of poisoning. The agents belonged to various groups: household products, agricultural pesticides, industrial chemicals, drugs, plants, animal bites and stings, miscellaneous and unknown groups respectively. The age ranged from less than 1 to 70 years, with the highest incidence in the range of 14-40 years, with males (57%) outnumbering females (43%). The most common mode of poisoning was suicidal (53%), followed by accidental (47%). The route of exposure was mainly oral (88%). Dermal (5%), inhalation and ocular exposure contributed 7% to the total. The highest incidence of poisoning was due to household agents (44.1%) followed by drugs (18.8%), agricultural pesticides (12.8%), industrial chemicals (8.9%), animals bites and stings (4.7%), plants (1.7%), unknown (2.9%) and miscellaneous groups (5.6%). Household products mainly comprised of pyrethroids, rodenticides, carbamates, phenyl, detergents, corrosives etc. Drugs implicated included benzodiazepines, anticonvulsants, analgesics, antihistamines, tricyclic antidepressants, thyroid hormones and oral contraceptives. Among the agricultural pesticides, aluminium phosphide was the most commonly consumed followed by organochlorines, organophosphates, ethylene dibromide, herbicides and fungicides. Copper sulphate and nitrobenzene were common among industrial chemicals. The bites and stings group comprised of snake bites, scorpion, wasp and bee stings. Poisoning due to plants was low, but datura was the most commonly ingested. An alarming feature of the study was the high incidence of poisoning in children (36.5%). The age ranged from less than 1 to 18 years and the most vulnerable age group included children from less than 1 year to 6 years. Accidental mode was the most common (79.7%). Intentional attempts were also noticed (20.2%) in the age group above 12 years. The present data may not give an exact picture of the incidence of poisoning in India, but represents a trend in our country. The Poisons Information Centre plays a vital role in providing timely management guidelines including the supply of necessary antidotes from the recently established National Antidote Bank, thereby helping to save precious lives.
Introduction: This is the 34th Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of 1 January 2016, 55 of the nation’s poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 9.50 [7.33, 14.6] (median [25%, 75%]) min, facilitating a near real-time national exposure and information database and surveillance system.
Methods: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1–6 to assess the Relative Contribution to Fatality (RCF) of the exposure.
Results: In 2016, 2,710,042 closed encounters were logged by NPDS: 2,159,032 human exposures, 54,019 animal exposures, 490,215 information cases, 6687 human confirmed non-exposures, and 89 animal confirmed non-exposures. US PCs also made 2,718,022 follow-up calls in 2016. Total encounters showed a 2.94% decline from 2015, while health care facility (HCF) human exposure cases increased by 3.63% from 2015. All information calls decreased by 12.5% but HCF information calls increased 0.454%, and while medication identification requests (Drug ID) decreased 29.6%, human exposure cases were essentially flat, decreasing by 0.431%. Human exposures with less serious outcomes have decreased 2.59% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.39% per year since 2000.
The top five substance classes most frequently involved in all human exposures were analgesics (11.2%), household cleaning substances (7.54%), cosmetics/personal care products (7.20%), sedatives/hypnotics/antipsychotics (5.84%), and antidepressants (4.74%). As a class, sedative/hypnotics/antipsychotics exposures increased most rapidly, by 10.7% per year (2088 cases/year), over the last 15 years for cases showing more serious outcomes. The top five most common exposures in children age 5 years or less were cosmetics/personal care products (13.3%), household cleaning substances (11.1%), analgesics (9.21%), foreign bodies/toys/miscellaneous (6.48%), and topical preparations (5.07%). Drug identification requests comprised 28.1% of all information calls. NPDS documented 1977 human exposures resulting in death; 1492 (75.5%) of these were judged as related (RCF of 1 – undoubtedly responsible, 2 – probably responsible, or 3 – contributory).
Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures, despite a decrease in cases involving less serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time, always current status of NPDS represents a national public health resource for collecting and monitoring US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g. foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. NPDS is a model system for the real-time surveillance of national and global public health.
Objective:
To explore the rational use of anticoagulants, especially among the elderly, balancing antithrombotic efficacy and risk for hemorrhage. Previous prospective studies have not provided powerful assessments of risk factors for intracranial hemorrhage, the dominant complication in reversing the anticoagulant decision.
Design:
Case-control analysis.
Setting:
A large general hospital and its anticoagulant therapy unit.
Patients:
121 consecutive adult patients taking warfarin who were hospitalized with intracranial hemorrhage were each matched to three contemporaneous controls randomly selected from among outpatients managed by our hospital anticoagulant therapy unit.
Results:
77 patients had intracerebral hemorrhage (46% fatal) and 44 had subdural hemorrhage (20% fatal). The prothrombin time ratio (PTR) was the dominant risk factor for intracranial hemorrhage. For each 0.5 increase in PTR over the entire range, the risk for intracerebral hemorrhage doubled (odds ratio, 2.1; 95% CI, 1.4 to 2.9). For subdural hemorrhage, the risk was unchanged over the PTR range from 1.0 to 2.0 but rose dramatically above a PTR of 2.0 (approximate international normalized ratio, 4.0). Age was the only other significant independent risk factor for subdural hemorrhage (odds ratio, 2.0 per decade; CI, 1.3 to 3.1). For intracerebral hemorrhage, age was of borderline significance (odds ratio, 1.3 per decade; CI, 1.0 to 1.6) after controlling for PTR and the two other independent risk factors: history of cerebrovascular disease (odds ratio, 3.1; CI, 1.7 to 5.6) and presence of a prosthetic heart valve (odds ratio, 2.8; CI, 1.3 to 5.8).
Conclusions:
The results emphasize the importance of maintaining the prothrombin time ratios under 2.0 and the need for especially careful use of warfarin in the elderly.
The study was carried out between 1994-2000 with three objectives, viz. a) to ascertain the various aspects of deaths due to poisoning, b) to analyze the probable reasons for the same and c) to find remedial measures to bring down the incidence of deaths by poisoning. Only those cases with a positive history of intake of or contact with some poisonous substance, thereby causing death, were included in the study. Age, Sex, Socio-economic and marital status, the poison alleged to have been consumed and its approximate quantity etc., were ascertained from various sources. The incidence in deaths due to poisoning was found to be persistently increasing. The age-group of 21-25 years, followed by 15-20 years, was the most prone to poisoning deaths. Male: female ratio was 2.5:1. Rural: urban ratio was 1.7:1. Among the male victims, married outnumbered the unmarried in rural community, while in the urban, reverse was observed. Among the females married outnumbered the unmarried in both the rural and urban communities. Aluminium Phosphide was found to be the drug of choice for suicides and suicide was the most common mode of poisoning. Based on the conclusions of the study various suggestions relating to decreasing the tensions of the modern mechanical life style, equal status for women in the society, educating the public in general, the rural population and the girl child, in particular; the use, storage and availability of the various insecticides and rodenticides, etc. have been put forward.
Sulfonylureas are used widely to treat hyperglycemia in elderly non-insulin-dependent diabetes mellitus (NIDDM) patients. Because this patient population is growing rapidly, it is likely that use of these agents will continue to increase. There is a considerable knowledge base regarding the clinical pharmacology, mechanism of action, and adverse side effects of these agents and >30 yr of clinical experience with their use. However, there is little specific information about these drugs in patients >65 yr of age and virtually no information about use of these drugs in people >85 yr of age. The effectiveness of sulfonylureas to lower glucose levels, the simplicity of dosing regimens, and their relative safety are all advantages for their use in an elderly NIDDM population. Disadvantages of these agents include the relatively low likelihood of achieving euglycemia, the risk of hypoglycemia, and a number of negative interactions with other drugs. In common with all other modalities used to treat hyperglycemia, of most concern is the lack of established benefit of these drugs to reduce the risk of long-term complications of diabetes mellitus. There is clearly a need for more information about the benefits and risks of the use of sulfonylureas in an elderly diabetic patient population.
Antipsychotics include the ‘typical’ agents (phenothiazines, thioxanthines and butyrophenones) as well as the more recently introduced agents referred to as ‘atypical’ (dibenzodiazepines, diphenylbutylpiperidines and benzamides). There are significant differences between these drugs in their toxicity in overdose. For example, thioridazine has been observed to be more cardiotoxic in overdose than other antipsychotic drugs, whereas clozapine and loxapine are the most likely to cause seizures.
Many antipsychotic overdoses will result in mild sedation and no other ill effect. Most patients can be safely discharged 6 hours after the poisoning, but it is critical to recognise the more seriously poisoned patient who will develop cardiotoxicity or seizures. These patients have ECG changes (QRS and/or QT prolongation) and decreased level of consciousness, and therefore require intensive care unit admission.
Treatment of antipsychotic overdose includes supportive care of the comatose patient, effective gastrointestinal decontamination with activated charcoal, intravenous fluids and ECG monitoring. Cardiotoxicity in antipsychotic overdose may manifest as ventricular arrhythmia, various degrees of conduction delay, or hypotension. The primary treatment of cardiotoxicity is plasma alkalinisation with sodium bicarbonate and hyperventilation. Neurotoxicity is manifest as coma and seizures. Treatment consists of intubation, hyperventilation and plasma alkalinisation.
Background:
Poisoning is recognized as an important health problem in many countries of the world. There is incomplete information on poisoning accidents, which is a major problem in developing countries.
Methods:
A cross-sectional analysis of hospital records of armed forces personnel admitted with a provisional diagnosis of unknown poisoning was carried out.
Result:
Unknown poisoning represented 0.25% of hospital admissions and 6584 man-hours were lost. 85% poisonings occurred at railway station and majority were food related. Average length of stay in the hospital was 14.69 days. Ten patients required intensive care and two patients were admitted to the psychiatry ward.
Conclusion:
Majority of the incidents occurred in railways, signifying the importance of health education and precaution while proceeding on leave. Since, most of the affected were young soldiers, education should start from recruiting centers. Few patients had alcohol intoxication reflecting their dependence potential and need for reinforcing prohibition on alcohol consumption during travel.
Careful monitoring is needed for adverse effects, particularly in the first month of treatment
Beta-blockers (BB) substantially improve survival in chronic heart failure and after myocardial infarction. However, concern about side-effects may deter clinicians from prescribing these life-saving drugs. In reality, absolute contraindications are rare. Only 3-5% of patients are intolerant because of hypotension or bradycardia. Data from randomized controlled trials and retrospective studies show that most patients eligible to receive BB tolerate them well. BB are not contraindicated in chronic obstructive pulmonary disease (COPD); in fact, these patients also benefit because of their high cardiovascular risk. In patients with COPD, as in the elderly, BB should be started at a low dose and uptitrated slowly. Monitoring of lung function during initiation is important, as undiagnosed coexistent asthma could be revealed. When patients are unaware of the drug in use, erectile dysfunction (ED) is reported no more often with BB than with any other drug prescribed for heart failure or hypertension. However, when patients are aware of the potential side-effects of BB, the resultant anxiety may cause ED. Patients should be reassured that BB prolong life and in the great majority are not the cause of ED, which may rather be related to the underlying disease (diabetes, hypertension, and atherosclerosis).
Drugs are the most frequent cause of hypoglycaemia in adults. Although hypoglycaemia is a well known adverse effect of antidiabetic agents, it may occasionally develop in the course of treatment with drugs used in everyday clinical practice, including NSAIDs, analgesics, antibacterials, antimalarials, antiarrhythmics, antidepressants and other miscellaneous agents. They induce hypoglycaemia by stimulating insulin release, reducing insulin clearance or interfering with glucose metabolism. Several drugs may also potentiate the hypoglycaemic effect of antidiabetic agents. Administration of these agents to individuals with diabetes mellitus is of most concern. Many of these drugs, and depending on clinical setting, may also induce hyperglycaemia. Drug-induced hepatotoxicity and nephrotoxicity may lead in certain circumstances to hypoglycaemia. Some drugs may also induce hypoglycaemia by causing pancreatitis. Drug-induced hypoglycaemia is usually mild but may be severe. Effective clinical management can be handled through awareness of this drug-induced adverse effect on blood glucose levels. Herein, we review pertinent clinical information on the incidence of drug-induced hypoglycaemia and discuss the underlying pathophysiological mechanisms, and prevention and management.
Background—Striking prolongation of the QT interval and the morphologically distinctive polymorphic ventricular tachycardia torsades de pointes can occur in patients treated with antiarrhythmic drugs and certain non-cardiovascular medications. However, there have been no reported cases of QT prolongation and torsades de pointes associated with the antiviral agent oseltamivir.
Stroke risk increases with age in patients who have nonvalvular atrial fibrillation. It is uncertain whether the efficacy of stroke prevention therapies in atrial fibrillation changes as patients age. The objective of this study was to determine the effect of age on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation.
This is an analysis of the Atrial Fibrillation Investigators database, which contains patient level-data from randomized trials of stroke prevention in atrial fibrillation. We used Cox regression models with age as a continuous variable that controlled for sex, year of randomization, and history of cerebrovascular disease, diabetes, hypertension, and congestive heart failure. Outcomes included ischemic stroke, serious bleeding (intracranial hemorrhage or systemic bleeding requiring hospitalization, transfusion, or surgery), and cardiovascular events (ischemic stroke, myocardial infarction, systemic embolism, or vascular death).
The analysis included 8932 patients and 17 685 years of observation from 12 trials. Patient age increased risk of ischemic stroke (adjusted hazard ratio per decade increase 1.45; 95% CI, 1.26 to 1.66), serious bleeding (1.61; 1.47 to 1.77), and cardiovascular events (1.43; 1.33 to 1.53). Compared with placebo, OAC and AP significantly reduced the risk of ischemic stroke (OAC, 0.36; 0.29 to 0.45; AP, 0.81; 0.72 to 0.90) and cardiovascular outcomes (OAC, 0.59; 0.52 to 0.66; AP, 0.81; 0.75 to 0.88), whereas OAC increased risk of serious bleeding (1.56; 1.03 to 2.37). The relative benefit of OAC versus placebo or AP did not vary by patient age for any outcome. Compared with placebo, the relative benefit of AP for preventing ischemic stroke decreased significantly as patients aged (P=0.01).
As patients with atrial fibrillation age, the relative efficacy of AP to prevent ischemic stroke appears to decrease, whereas it does not change for OAC. Because stroke risk increases with age, the absolute benefit of OAC increases as patients get older.
Aspirin (acetylsalicylic acid) and its salicylate derivatives are effective antipyretic, analgesic, and anti-inflammatory agents that are still very widely used by the elderly despite the advent of newer, potentially safer nonsteroidal anti-inflammatory drugs (NSAIDs). However, none of the new NSAIDs have been proven to be more effective than aspirin or salicylic acid. Chronic salicylate intoxication which is most common in the elderly, may occur with therapeutic doses. Increased toxicity in older patients often appears due to inadvertent overdosage. Dual prescribing or additional use of nonprescription salicylates are some causes of unwitting long term toxicity. According to some studies, systemic clearance of salicylate (mainly by hepatic metabolism) is reduced with age, as is renal elimination. These changes are of increased importance in the elderly using high therapeutic doses of salicylates when metabolism is saturated and more unchanged drug is available for renal excretion. In the face of renal impairment, the risk of toxicity is increased. The diagnosis of acute salicylate intoxication generally does not pose diagnostic problems. Patients often present with a history of intentional overdose, with hyperventilation, fever, and nausea. The diagnosis can be confirmed by measuring serum salicylate concentrations. Chronic intoxication often poses a diagnostic dilemma with atypical presentations mimicking other disease states such as diabetic ketoacidosis, delirium, cerebrovascular accident, myocardial infarction or cardiac failure. The diagnosis of salicylate intoxication should be borne in mind when an older patient presents with recent deterioration in activities of daily living with no known cause. Plasma salicylate concentrations should be measured if salicylate intoxication is suspected, even if there is no documented history of salicylate ingestion. The risk of salicylate nephrotoxicity is also increased with age, and upper gastrointestinal haemorrhage is associated with increased mortality in older age groups. Treatment of acute toxicity consists of prompt recognition of salicylate intoxication, use of activated charcoal, correction of acid-base abnormalities, general supportive measures, and if concentrations are extremely high, dialysis can be effectively used. Chronic toxicity, which can occur even with marginally high salicylate concentrations, is treated with drug withdrawal and supportive therapy. Chronic salicylate toxicity can be averted by prescription of conservative doses of drug, avoidance of concomitant use of different salicylate preparations, and therapeutic monitoring to guide dosage. Renal function should be monitored to detect nephrotoxicity from chronic salicylate therapy. Patients should be regularly screened for evidence of gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs worldwide when grouped by generic categories and account for 3 to 9% of total prescription numbers in various countries. While NSAIDs are responsible for approximately 25% of all reported adverse drug reactions, aging may substantially increase the risk of NSAID-induced reactions.
Several factors may contribute to NSAID-related toxicity in the elderly. The increase in morbidity associated with aging may result in consumption of a wide range of potent drugs, while inappropriate drug therapy and aberrant compliance are also capable of contributing to adverse drug reactions in geriatric patients. Age-related alterations in pharmacokinetics may influence the handling of NSAIDs in the elderly; in particular, dosage reduction is appropriate for azapropazone (apazone), naproxen, ketoprofen and salicylates administered to healthy aged patients, whereas the presence of renal disease may also necessitate dosage reduction of diflunisal, indomethacin, sulindac and mefenamic acid. Changes in NSAID pharmacodynamics with aging, such as increased CNS sensitivity to NSAIDs and impaired homeostasis, also predispose the elderly to NSAID-related adverse effects.
It is undisputed that gastrointestinal toxicity due to NSAID therapy is a class effect. A significant association has been found between aspirin and uncomplicated gastric, but not uncomplicated duodenal ulcer, while nonaspirin NSAIDs are significantly associated with both uncomplicated gastric and duodenal ulceration. The use of NSAIDs is accompanied by a 2- to 5-fold risk of serious complications of peptic ulcer disease, i.e. haemorrhage or perforation, which increases in the elderly, particularly women. A broad range of renal side effects has been ascribed to NSAIDs, of which acute renal impairment is the most common in the elderly. Although most NSAIDs have been reported to cause hepatotoxicity, serious abnormalities of liver function are rare and are largely unpredictable. Other adverse effects due to NSAIDs have also been described, some of which (e.g. cardiovascular, CNS and haematological effects) may be more common in the elderly.
The incidence of digoxin toxicity increases with age, largely because the two most common conditions that benefit from use of digoxin, congestive heart failure and atrial fibrillation, are markedly more prevalent in old age. Whether the elderly are more sensitive to the effects of digoxin because of age per se is unclear. However, several other factors render the elderly more susceptible to digoxin toxicity. These include an age-related decline in renal function and a decrease in volume of digoxin distribution. There is also an increase in the number of comorbid conditions, including cardiovascular and chronic obstructive pulmonary disease, which heighten susceptibility to digoxin toxicity. Moreover, treatment of these diseases with such interactive medications as quinidine and calcium channel blockers may increase the serum level of digoxin. Similarly, such electrolyte imbalances as hypokalemia and hypomagnesemia occur more frequently in the elderly as a result of diuretic therapy. However, recent data suggest that manifestations of digoxin toxicity among younger and older patients do not differ. Similar incidences of cardiac toxicity, gastrointestinal toxicity, and altered mental status are found in both patient populations. Treatment of digitalis toxicity in the elderly is the same as for younger patients. Response rates to Digibind are not diminished in the elderly.
Previous reports have suggested that piroxicam may be more ulcerogenic than other non-steroidal anti-inflammatory drugs (NSAIDs) in use. Critics have attributed this putative relation to flawed comparisons of spontaneously reported data. In this study cases of upper gastrointestinal bleeding, perforation, and ulcer reported to the Food and Drug Administration's spontaneous reporting system over 12 years were examined. Reporting rates for eight NSAIDs were compared over identical periods of their marketing life cycles. After adjustments were made for the heterogeneity in the underlying reporting rates the difference in rates between piroxicam and the other drugs was considerably reduced but piroxicam retained its top ranking among the drugs; however, large and clinically important differences in the frequency of cases of upper gastrointestinal bleeding, perforation, and ulcer between piroxicam and the rest of the NSAIDs compared probably do not exist.
Currently available guidelines for managing theophylline intoxication do not distinguish between acute single ingestion and chronic repeated overmedication and do not reliably predict which patients should undergo hemoperfusion. Although hemoperfusion is widely recommended when serum concentrations exceed 40-60 mg/l, many patients with acute overdose tolerate much higher levels without serious toxicity. Because manifestations of toxicity might be dependent on the chronicity of the overdose, the authors retrospectively compared the clinical features of 15 patients with chronic repeated overmedication with those of 27 patients suffering acute single overdose. Patients suffering chronic repeated overmedication developed seizures (7/15) and serious arrhythmias (4/15) with serum levels of 28-70 mg/l. By contrast, only one of 19 patients suffering acute single overdose with peak levels less than 100 mg/l had seizures, and only two of 19 with levels less than 100 mg/l had serious arrhythmias. However, of the eight single-overdose patients with levels over 100 mg/l, seven had seizures and three had serious arrhythmias. Single-overdose patients were easily recognized by the presence of hypotension, hypokalemia, and low serum bicarbonate, features not present in chronic-type patients. Thus, while patients with theophylline overdose caused by chronic repeated overmedication frequently develop seizures and arrhythmias with serum levels of 40-70 mg/l, those with acute single ingestion are highly unlikely to suffer serious complications unless serum levels exceed 100 mg/l. Management of the intoxication, especially selection of patients for hemoperfusion, should be based on whether the overdose is caused by an acute single ingestion or chronic repeated overmedication.
Successful injury control measures (stoplights, sprinkler systems, electrical insulation, evacuation) have long been commonplace. However, progress in injury control has been hampered by the failure to recognize that injuries cannot occur without the action of specific agents analogous to those of the infectious diseases and likewise transmitted by vehicles and vectors. These agents are the several forms of injury. Varying and interacting with the characteristics of the host and the environment, they constitute the classic epidemiologic triads that determine injury distributions, none of which are random. The injury-disease dichotomy, a universal in most of the world's major languages, may have resulted from the fact that at least some of the causes of injuries (for example, wild animals or falling trees) are more identifiable and proximate than the causes of diseases. The etiology of injuries suggests that for epidemiologic and public health purposes, the term injury should probably be defined so as to encompass those kinds of damage to the body that are produced by energy exchanges and that are manifested within 48 hours, or usually within considerably shorter periods. Strategies for injury control can be extended to the control of other pathological conditions. The active-passive distinction (the dimension expressing the extent to which control measures require people to do something) has a direct bearing on the success of public health programs, because passive approaches have historically had a far better record of success than active ones. Ten basic strategies have been identified that provide options for reducing the damage to people (and property) caused by all kinds of environmental hazards.
This review provides an updated overview of the adverse effects of sulphonylureas and identifies factors associated with variation in adverse effect rates among sulphonylureas published by different studies. A search of Medline, Embase, Current Contents and Cochrane Library was conducted to identify all papers related to sulphonylureas and adverse effects published from 1950-2001. The reference lists of all relevant papers were also searched for additional articles. The frequency of sulphonylurea-induced hypoglycaemia varied from 1.8-59%. Severe hypoglycaemia due to sulphonylurea use has been reported from 1.9-3.5%. Variation in hypoglycaemia rates may be due to differences in definitions, methods to detect and to collect information, patient characteristics, patient knowledge of the condition, threshold for symptoms, and activity level during hypoglycaemia. Other adverse effects associated with sulphonylurea use include bodyweight gain, gastrointestinal distress, disulphiram-like syndrome, dermatological reactions, haematological changes, ocular problems, and the syndrome of inappropriate secretion of antidiuretic hormone. Bodyweight gain has been reported to vary from 1.7-4.8 kg, according to the United Kingdom Prospective Diabetes Study (UKPDS-33). Controversy exists regarding cardiovascular adverse effects, but the consensus is to exercise caution in the use of these drugs as first-line therapy for patients with diabetes mellitus and coronary artery disease. The benefits of sulphonylurea treatment should be weighed against the risks associated with them. More work in this area is needed to homogenise the definition of hypoglycaemia, to get consensus on the methods for detection and data collection, as well as to further patient and physician education.
The clinical use of theophylline as a first-line bronchodilator has declined during the last two decades. However, in many clinical settings, such as an emergency bronchial asthma attack, theophylline may have a first-line role, in combination with β2-adrenoreceptor agonists and corticosteroids, for improving the asthmatic status. Furthermore, many therapeutic mechanisms of theophylline for bronchial asthma have been reported, and recent studies have suggested that theophylline therapy may have a beneficial role in the management of chronic stable asthma as well as exacerbated disease. However, theophylline has a low therapeutic index because the bronchodilation it produces has a linear relationship with logarithmic increases in serum concentration for the therapeutic range of 5–20 mg/L. Thus, the knowledge of its basic pharmacokinetics and the factors that can alter its clearance is clinically relevant for physicians.
Especially when used in elderly asthmatic patients, dosage adjustment of theophylline is a requisite since the elderly have several risk factors that may increase the plasma theophylline level, such as reduced clearance, various underlying diseases and multiple coadministered drugs. After theophylline treatment has been initiated, therapeutic drug monitoring is required.
Ninety-nine percent of fatal poisonings occur in developing countries, particularly among agricultural workers. In a particular area, it is important to known the magnitude and pattern of acute poisonings, as it is important for early diagnosis and treatment and also for preventive measures.
Hospital records of all unnatural causes of deaths were reviewed at Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra during the five years period, 1997-2001. Autopsy records in fatal poisonings were studied for age, sex, residence, marital status, type of poison and manner of poisoning (accidental, suicidal or homicidal). Admission and death rates of acute poisonings were compared with those from other unnatural causes.
Acute poisoning is the leading most cause of unnatural deaths and third common cause of emergency hospitalizations in this rural part of India. Of all fatal cases, 67% were males, 63% married, 83% with rural residence and 63.4% suicides. Responsible poison could not be ascertained in 16% of clinical and 9.9% of fatal cases. Insecticides were responsible for 35% of clinical and 55.4% of fatal cases.
Young married males of rural background with agricultural occupation and failure of monsoon are the risk factors associated with poisoning cases.
To describe alprazolam poisoning and the relative toxicity of alprazolam compared with other benzodiazepines.
A database of consecutive poisoning admissions to a regional toxicology service was searched to identify consecutive benzodiazepine deliberate self poisonings, which were coded as alprazolam, diazepam or other benzodiazepine. Major outcomes used were length of stay (LOS), intensive care (ICU) admission, coma (GCS < 9), flumazenil administration and requirement for mechanical ventilation. Prescription data were obtained for benzodiazepines for the study period.
There were 2063 single benzodiazepine overdose admissions: 131 alprazolam overdoses, 823 diazepam overdoses and 1109 other benzodiazepine overdoses. The median LOS for alprazolam overdoses was 19 h which was 1.27 (95% CI 1.04, 1.54) times longer compared with other benzodiazepines by multiple linear regression. For patients with alprazolam overdoses, 22% were admitted to ICU which was 2.06 (95% CI 1.27, 3.33) times more likely compared with other benzodiazepines after multivariate analysis adjusting for age, dose, gender, time to ingestion and co-ingested drugs. Flumazenil was administered to 14% of alprazolam patients and 16% were ventilated, which was significantly more than for other benzodiazepine overdoses (8% and 11%, respectively). Twelve percent of alprazolam overdoses had a GCS < 9 compared with 10% for other benzodiazepines. From benzodiazepine prescription data, total alprazolam prescriptions in Australia increased from 0.13 million in 1992 to 0.41 million in 2001. Eighty five percent of prescriptions were for panic disorder, anxiety, depression or mixed anxiety/depression.
Alprazolam was significantly more toxic than other benzodiazepines. The increased prescription of alprazolam to groups with an increased risk of deliberate self poisoning is concerning and needs review.
Benzodiazepine poisoning in elderly
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- Stosi Djordjevi C S
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