Goga R, de Vasconcellos K, Singh D
Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Critical Care, King Edward VIII Hospital, Durban, South Africa; Department of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
South Afr J Crit Care. 2021 Mar 17;37(1). doi: 10.7196/SAJCC.2021.v37i1.408. eCollection 2021.
Acute poisoning is a potentially preventable burden on the healthcare systems and a significant cause of morbidity and mortality worldwide. Improved knowledge of the patterns of poisoning, the clinical course and outcomes of these cases may help create better preventive and management approaches.
To describe the demographics, clinical characteristics and outcomes of patients with acute poisonings who were admitted to a multidisciplinary intensive care unit (ICU) at King Edward VIII Hospital, Durban, South Africa.
A retrospective observational chart review of patients admitted to the study ICU with acute poisoning over a 24-month period (1 July 2015 - 30 June 2017).
A total of 85 patients with acute poisoning were admitted to the ICU during the study period. There was a female preponderance (55%) with a median age of 28 years. ICU mortality was 16.5% with a median ICU length of stay of 3 days. Tricyclic antidepressants (TCA) were the most common toxin identified (16.5%). The ingestion of amphetamines was associated with a statistically significant increase in mortality (100.0% v. 13.4%; =0.04). Ethylene glycol was a commonly ingested toxin (9.4% of admissions) and had a high mortality rate of 37.5% that was not statistically significant (=0.121). Referral for inotropic support, a Glasgow Coma Scale ≤5 and metabolic acidosis on admission were associated with higher ICU mortality.
Acute poisoning results in potentially preventable ICU admission and mortality. TCA poisoning was the most common presentation and this warrants review of TCA prescription practice. Ingestion of illicit drugs, ethylene glycol or presentation with a markedly reduced level of consciousness, shock or metabolic acidosis should alert treating physicians to a possible elevated risk of adverse outcomes.
This is the first study to describe acute poisoning patterns in KwaZulu-Natal from a critical care perspective. This will increase knowledge of common toxins and the presentations that lead to critical care referral. Furthermore, prescription practices for common toxins like TCAs need to be reviewed as a prevention strategy.
急性中毒是医疗系统中潜在可预防的负担，也是全球发病和死亡的重要原因。提高对中毒模式、这些病例的临床病程和结局的认识，可能有助于制定更好的预防和管理方法。
描述南非德班爱德华八世国王医院多学科重症监护病房（ICU）收治的急性中毒患者的人口统计学特征、临床特征和结局。
对研究期间（2015年7月1日至2017年6月30日）入住研究ICU的急性中毒患者进行回顾性观察图表审查。
研究期间共有85例急性中毒患者入住ICU。女性占多数（55%），中位年龄为28岁。ICU死亡率为16.5%，中位ICU住院时间为3天。三环类抗抑郁药（TCA）是最常见的鉴定出的毒素（16.5%）。苯丙胺摄入与死亡率的统计学显著增加相关（100.0%对13.4%；P=0.04）。乙二醇是一种常见的摄入毒素（占入院患者的9.4%），死亡率高达37.5%，但无统计学显著性（P=0.121）。入住时接受正性肌力支持、格拉斯哥昏迷量表评分≤5分和代谢性酸中毒与较高的ICU死亡率相关。
急性中毒导致潜在可预防的ICU入院和死亡。TCA中毒是最常见的表现形式，这值得对TCA处方实践进行审查。非法药物、乙二醇的摄入或意识水平明显降低、休克或代谢性酸中毒的表现应提醒治疗医生注意不良结局的风险可能升高。
这是第一项从重症监护角度描述夸祖鲁-纳塔尔省急性中毒模式的研究。这将增加对常见毒素以及导致重症监护转诊的表现的认识。此外，作为一种预防策略，需要审查TCA等常见毒素的处方实践。
