1 The clinical course in an unselected group of 1125 consecutively hospitalised self-poisonings was studied during 1 year in Oslo.
2 Mortality was 0.5%, but only 0.3% in those admitted without cardiac and respiratory arrest. Mortality among those in grade IV coma was 4.2%.
3 The deepest comas (grade III or IV) occurred in 25.1% of the admissions with a mean duration of the coma of 5.8 h (range 1-80).
4 Complications occurred in 21.7% of the admissions and 6.9% suffered more than one complication of which the most frequent were respiratory depression (13.5%), hypotension (5.3%), pneumonia (4.4%), and hypothermia (1.6%). The complication rate was highest in poisonings with opiates (60.7%), meprobamate (37.5%) and antihistamines (30.0%).
5 Arrhythmias and respiratory depression were closely associated with poisonings with antidepressants and opiates, respectively. Owing to frequent polydrug overdoses it was difficult to associate other complications with other main toxic agents.
6 Administration of antidotes (20.6%), cuffed intubation (4.4%) and forced alkaline diuresis (3.4%) were the most frequent special therapeutic measures taken.
7 The change in pattern of self-poisonings in Oslo focuses on antidote therapy and intensive care, especially outside hospital, but limits the need for haemodialysis and haemoperfusion which were performed in only 1.0% of the admissions.
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References
1.
Arieff, A.I. & Friedmann, E.A. (1973). Coma following nonnarcotic drug overdesage: Management of 208 adult patients. Am. J. Med. Sci., 266, 405-426.
2.
De Groot, G., Maes, R.A.A. & Van Heijst, A.N.P. (1980). A toxicological evaluation of hemoperfusion using pharmacokinetic principles. Dev. Toxicol. Environ. Sci., 8, 387-395.
3.
Heath, A. & Selander, D. (1979). Self-poisoning treated in the ICU. Acta Med. Scand., 206, 51-54.
4.
Heath, A., Wickstrm, I., Maartensson, E. & Ahlmén, J. (1982). Treatment of antidepressant poisoning with resin hemoperfusion. Human Toxicol, 1, 361-371.
5.
Jacobsen, D., Frederichsen, P.S., Knutsen, K.M., Srum, Y., Talseth, T. & Degaard, O.R. (1984). A prospective study of 1212 cases of acute poisoning: general epidemiology. Human Toxicol., 3, 93-106
6.
Jeffcoate, W.J., Cullen, M.H., Herbert, M., Hastings, A.G. & Walder, G.P. (1979). Prevention of effects of alcohol intoxication by naloxone. Lancet, 2, 1157-1159.
7.
Jefferys, D.B., Flanagan, R.F. & Volans, G.N. (1980). Reversal of ethanol-induced coma with naloxone . Lancet, 1, 308-309.
8.
Mattew, H. & Lawson, A.A.H. (1975). Treatment of common acute poisonings, 3rd edn. Edinburgh : Churchill Livingstone.
9.
Newton, R.W. (1975). Physostigmine salicylate in the treatment of tricyclic antidepressant overdosage. JAMA, 231, 941-943.
10.
Pedersen, O.L., Gram, L.F., Kristensen, C.B., Moller, M., Thayssen, P., Bjerre, M., Kragh—Sörensen, P., Klitgaard, N.A.,Sindrup, E., Hole, P. & Brinklöv, M., (1982). Overdosage of antidepressants: clinical and pharmacokinetic aspects. Eur. J. Clin. Pharmacol., 23, 513-521.
11.
Prescott, L.F., Illingworth, R.N., Critchley, J.A.J.H., Stewart, M.J., Adam, R.D. & Proudfoot, A.T. (1979). Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. Br. Med. J., 2, 1097-1100.
12.
Proudfoot, A.T. & Park, J. (1978). Changing pattern of drugs used for self-poisoning . Br. Med. J., 1, 90-93.
13.
Rygnestad, T.K. (1982). Prospective study of social and psychiatric aspects in self-poisoned patients. Acta Psychiat. Scand., 66, 139-153.
14.
Saltvedt, E., Wiik-Larsen, E., Skuterud, B., Pettersen, J.E., Lunde, P.K.M. & Enger, E. (1977). Centralized treatment of acute drug poisonings - clinical and toxicological experiences. Tidsskr. Nor. Laegeforen. (Engl. abstr.), 97, 227-232.
