Clinical and Epidemiological Characteristics of Severe Acute Adult Poisoning Cases in Martinique: Implicated Toxic Exposures and Their Outcomes
Abstract
:1. Introduction
2. Methods
3. Statistical Analysis
4. Results
5. Discussion
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Total Population | Non Survivors | Survivors | p | |||
---|---|---|---|---|---|---|---|
Nb | Result | Nb | Result | Nb | Result | ||
Age (years) | 291 | 46 ± 19 | 30 | 56 ± 18 | 261 | 45 ± 18 | 0.001 |
Male gender | 291 | 166 (57%) | 30 | 17 (56.7%) | 261 | 149 (57.1%) | 0.965 |
Medical history | |||||||
Psychiatric disorder | 287 | 143 (49.8%) | 30 | 14 (46.7%) | 257 | 129 (50.2%) | 0.865 |
Drug intoxication | 284 | 65 (22.9%) | 29 | 1 (3.4%) | 255 | 64 (25.1%) | 0.031 |
Alcohol abuse | 284 | 59 (20.8%) | 29 | 6 (20.7%) | 255 | 53 (20.8%) | 0.940 |
Hospitalization | |||||||
Emergency Department | 287 | 185 (64.5%) | 30 | 19 (63.3%) | 257 | 166 (64.6%) | 0.785 |
Medical ward | 288 | 26 (9%) | 29 | 4 (13.8%) | 259 | 22 (8.5%) | 0.271 |
Level 3 ICU | 288 | 227 (78.8%) | 30 | 23 (76.7%) | 258 | 204 (79.1%) | 0.802 |
Level 2 ICU | 290 | 71 (24.5%) | 30 | 6 (20%) | 260 | 65 (25%) | 0.787 |
Severity | |||||||
PSS | 289 | 2.7 ± 0.8 | 30 | 4 ± 0 | 259 | 2.5 ± 0.7 | 0.000 |
SAPS II | 191 | 39 ± 23 | 19 | 71 ± 19 | 172 | 36 ± 20 | 0.000 |
Issue | |||||||
Hospital Length of stay | 290 | 6 ± 7 | 30 | 5 ± 8 | 260 | 6 ± 7 | 0.750 |
1 day | 290 | 18 (6.2%) | 30 | 8 (26.7%) | 260 | 10 (3.8%) | - |
2 to 7 days | 290 | 225 (77.3%) | 30 | 17 (56.7%) | 260 | 208 (80%) | - |
8 to 14 days | 290 | 21 (7.2%) | 30 | 3 (10%) | 260 | 18 (6.9%) | - |
>15 days | 290 | 26 (8.9%) | 30 | 2 (6.7%) | 260 | 24 (9.2%) | - |
Cardiac arrest | 291 | 34 (11.7%) | 30 | 30 (100%) | 261 | 4 (1.5%) | 0.000 |
Death | 291 | 30 (10.3%) | 30 | 30 (100%) | 261 | 0 (0%) | - |
Variable | Total Population | Non-Survivors | Survivors | p | |||
---|---|---|---|---|---|---|---|
Nb | Result | Nb | Result | Nb | Result | ||
Therapeutic drug intoxication | 291 | 169 (58.1%) | 30 | 11 (36.7%) | 261 | 158 (60.5%) | 0.012 |
Nb of therapeutic drug involved | 291 | 1.2 ± 1.3 | 30 | 0.6 ± 0.9 | 261 | 1.3 ± 1.3 | 0.090 |
Antipsychotics | 291 | 116 (39.9%) | 30 | 4 (13.3%) | 261 | 112 (42.9%) | 0.002 |
Benzodiazepines | 291 | 76 (26.1%) | 30 | 2 (6.7%) | 261 | 74 (28.4%) | 0.010 |
Barbiturates | 291 | 3 (1%) | 30 | 0 (0%) | 261 | 3 (1.1%) | 0.555 |
Neuroleptics | 291 | 33 (11.3%) | 30 | 1 (3.3%) | 261 | 32 (12.3%) | 0.144 |
Lithium | 291 | 4 (1.4%) | 30 | 0 (0%) | 261 | 4 (1.5%) | 0.495 |
Tricyclic antidepressants | 291 | 18 (6.2%) | 30 | 1 (3.3%) | 261 | 17 (6.5%) | 0.493 |
Carbamate | 291 | 4 (1.4%) | 30 | 0 (0%) | 261 | 4 (1.5%) | 0.495 |
Cardiotrops | 291 | 26 (8.9%) | 30 | 3 (10%) | 261 | 23 (8.8%) | 0.829 |
Antiarrhythmics | 291 | 3 (1%) | 30 | 0 (0%) | 261 | 3 (1.1%) | 0.555 |
Β-Blockers | 291 | 10 (3.4%) | 30 | 2 (6.7%) | 261 | 8 (3.1%) | 0.305 |
Calcium inhibitors | 291 | 7 (2.4%) | 30 | 1 (3.3%) | 261 | 6 (2.3%) | 0.726 |
Analgesics | 291 | 16 (5.5%) | 30 | 1 (3.3%) | 261 | 15 (5.7%) | 0.583 |
Paracetamol | 291 | 15 (5.2%) | 30 | 1 (3.3%) | 261 | 14 (5.4%) | 0.634 |
Chloroquine | 291 | 1 (0.3%) | 30 | 0 (0%) | 261 | 1 (0.4%) | 0.734 |
Insulin | 291 | 3 (1%) | 30 | 0 (0%) | 261 | 3 (1.1%) | 0.555 |
Other therapeutic drugs | 291 | 17 (5.8%) | 30 | 3 (10%) | 261 | 14 (5.4%) | 0.305 |
Chemical intoxication | 291 | 152 (52.2%) | 30 | 19 (63.3%) | 261 | 133 (51%) | 0.199 |
Nb of chemical products involved | 291 | 0.8 ± 0.9 | 30 | 0.9 ± 0.9 | 261 | 0.7 ± 0.9 | 0.250 |
Herbicides | 291 | 29 (10%) | 30 | 6 (20%) | 261 | 23 (8.8%) | 0.053 |
Aldicarb | 291 | 23 (7.9%) | 30 | 0 (0%) | 261 | 23 (8.8%) | 0.090 |
Organophosphorus | 291 | 22 (7.6%) | 30 | 2 (6.7%) | 261 | 20 (7.7%) | 0.845 |
Gramoxone | 291 | 6 (2.1%) | 30 | 5 (16.7%) | 261 | 1 (0.4%) | 0.000 |
Chloralose | 291 | 8 (2.7%) | 30 | 0 (0%) | 261 | 8 (3.1%) | 0.331 |
Rubigine® | 291 | 28 (9.6%) | 30 | 4 (13.3%) | 261 | 24 (9.2%) | 0.467 |
Caustics | 291 | 23 (7.9%) | 30 | 1 (3.3%) | 261 | 22 (8.4%) | 0.327 |
Ethylene glycol | 291 | 2 (0.7%) | 30 | 0 (0%) | 261 | 2 (0.8%) | 0.630 |
Formaldehyde | 291 | 1 (0.3%) | 30 | 1 (3.3%) | 261 | 0 (0%) | 0.003 |
Crack cocaine | 291 | 1 (0.3%) | 30 | 0 (0%) | 261 | 1 (0.4%) | 0.734 |
Cocaine | 291 | 4 (1.4%) | 30 | 1 (3.3%) | 261 | 3 (1.1%) | 0.331 |
Cannabis | 291 | 4 (1.4%) | 30 | 0 (0%) | 261 | 4 (1.5%) | 0.495 |
OH3 | 291 | 56 (19.2%) | 30 | 5 (16.7%) | 261 | 51 (19.5%) | 0.705 |
Fruits | 291 | 5 (1.7%) | 30 | 2 (6.7%) | 261 | 3 (1.1%) | 0.028 |
Ciguatoxine | 291 | 1 (0.3%) | 30 | 0 (0%) | 261 | 1 (0.4%) | 0.734 |
Mixed therapeutic and chemical toxic | 291 | 30 (10.3%) | 30 | 0 (0%) | 261 | 30 (11.5%) | 0.050 |
Nb of toxicant involved | 291 | 1.1 ± 0.3 | 30 | 1 ± 0 | 261 | 1.1 ± 0.3 | 0.005 |
Multiple therapeutic drugs intoxication | 169 | 61 (36.1%) | 11 | 2 (18.2%) | 158 | 59 (37.3%) | 0.025 |
Multiple chemical intoxication | 152 | 48 (31.6%) | 19 | 7 (36.8%) | 133 | 41 (30.8%) | 0.371 |
Drug overdose | 291 | 37 (12.7%) | 30 | 7 (23.3%) | 261 | 30 (11.5%) | 0.065 |
Intentional self-poisoning | 289 | 250 (86.5%) | 30 | 24 (80%) | 259 | 226 (87.3%) | 0.484 |
Parameter | Normal Range | Total Population | Non Survivors | Survivors | p | |||
---|---|---|---|---|---|---|---|---|
Number | Result | Number | Result | Number | Result | |||
Temperature (°C) | 36.1–37.5 | 74 | 36.6 ± 1.6 | 11 | 36.2 ± 2.3 | 63 | 36.7 ± 1.4 | 0.361 |
Breath rhythm (breath/min) | 16–20 | 50 | 25 ± 19 | 9 | 44 ± 37 | 41 | 21 ± 7 | 0.000 |
SaO2 (%) | 92–100 | 94 | 94 ± 9 | 10 | 90 ± 10 | 84 | 94 ± 9 | 0.099 |
Cardiac rhythm (beat/min) | 60–90 | 179 | 89 ± 28 | 23 | 85 ± 30 | 156 | 90 ± 28 | 0.472 |
Shock | - | 291 | 78 (26.8%) | 30 | 28 (93.3%) | 261 | 50 (19.2%) | 0.000 |
Ventricular fibrillation or tachycardia | - | 291 | 8 (2.7%) | 30 | 7 (23.3%) | 261 | 1 (0.4%) | 0.000 |
GCS | 15 | 227 | 9 ± 4 | 21 | 9 ± 5 | 206 | 8 ± 4 | 0.860 |
Seizures | - | 291 | 31 (10.7%) | 30 | 5 (16.7%) | 261 | 26 (10%) | 0.260 |
Myoclonus | - | 291 | 28 (9.6%) | 30 | 1 (3.3%) | 261 | 27 (10.3%) | 0.217 |
Gastro-intestinal disorders | - | 291 | 78 (26.8%) | 30 | 14 (46.7%) | 261 | 64 (24.5%) | 0.010 |
Pneumonia | - | 291 | 49 (16.8%) | 30 | 7 (23.3%) | 261 | 42 (16.1%) | 0.315 |
Conjunctivitis | - | 291 | 3 (1%) | 30 | 0 (0%) | 261 | 3 (1.1%) | 0.555 |
Other infections | - | 291 | 77 (26.5%) | 30 | 10 (33.3%) | 261 | 67 (25.7%) | 0.173 |
Biology | ||||||||
pH | 7.40 ± 0.02 | 81 | 7.30 ± 0.20 | 17 | 7.20 ± 0.20 | 64 | 7.30 ± 0.20 | 0.092 |
Alkaline reserve (mmol/L) | 22–29 | 66 | 19.3 ± 7.1 | 13 | 15.2 ± 6.3 | 53 | 20.3 ± 7 | 0.019 |
PaCO2 (mmHg) | 35–45 | 68 | 39.8 ± 15 | 10 | 40.5 ± 18.8 | 58 | 39.6 ± 14.4 | 0.867 |
Lactate (mmol/L) | 0.5–2.2 | 53 | 6.4 ± 5.9 | 9 | 11.1 ± 7.7 | 44 | 5.4 ± 5 | 0.006 |
Hyper lactacidemia | - | 53 | 37 (69.8%) | 9 | 8 (88.9%) | 44 | 29 (65.9%) | 0.171 |
Sodium (mmol/L) | 136–145 | 59 | 139 ± 8 | 8 | 136 ± 9 | 51 | 139 ± 7 | 0.225 |
Potassium (mmol/L) | 3.5–5.1 | 82 | 4 ± 1.3 | 12 | 5.4 ± 1.5 | 70 | 3.8 ± 1.1 | 0.000 |
Hypokalemia | - | 82 | 26 (31.7%) | 12 | 1 (8.3%) | 70 | 25 (35.7%) | 0.029 |
Hyperkalemia | - | 82 | 13 (15.9%) | 12 | 7 (58.3%) | 70 | 6 (8.6%) | 0.000 |
Calcium (mmol/L) | 2.15–2.55 | 33 | 2.1 ± 0.4 | 2 | 1.4 ± 0.2 | 31 | 2.1 ± 0.4 | 0.029 |
Magnesium (mmol/L) | 0.75–0.90 | 10 | 0.9 ± 0.2 | 2 | 0.8 ± 0.1 | 8 | 0.9 ± 0.3 | 0.497 |
Phosphorus (mmol/L) | 0.80–1.35 | 22 | 1.1 ± 0.6 | 1 | 1.27 | 21 | 1.1 ± 0.6 | 0.805 |
Creatinine (µmol/L) | 62–106 | 90 | 220 ± 213 | 15 | 270 ± 179 | 75 | 210 ± 219 | 0.317 |
Urea nitrogen (mmol/L) | 1.7–8.3 | 73 | 15 ± 34 | 10 | 43 ± 87.8 | 63 | 10.6 ± 8.9 | 0.004 |
Creatine Kinase (IU/L) | 38–174 | 34 | 15,974 ± 45,164 | 5 | 38,193 ± 44,310 | 29 | 12,143 ± 44,947 | 0.000 |
Rhabdomyolysis | - | 34 | 20 (58.8%) | 5 | 5 (100%) | 29 | 15 (51.7%) | 0.041 |
Troponins (µg/L) | 0–0.014 | 15 | 0.8 ± 1.9 | 4 | 0.5 ± 0.6 | 11 | 0.9 ± 2.2 | 0.700 |
Elevated troponins | - | 3 | 3 (100%) | 1 | 1 (100%) | 2 | 2 (100%) | 0.187 |
Glycaemia (mmol/L) | 3.9–7.1 | 12 | 8.3 ± 5.1 | 2 | 4.6 ± 6 | 10 | 9.1 ± 4.9 | 0.270 |
Aspartate aminotransferases (AST) (IU/L) | <37 | 43 | 1968 ± 3894 | 6 | 5452 ± 4317 | 37 | 1403 ± 3570 | 0.042 |
Alanine aminotransferases (ALT) (IU/L) | <40 | 43 | 961 ± 2211 | 6 | 2431 ± 2574 | 37 | 723 ± 2089 | 0.239 |
Platelet count (Giga/L) | 150–400 | 29 | 152 ± 95 | 7 | 75 ± 74 | 22 | 177 ± 88 | 0.010 |
Prothrombine time (%) | 60–100 | 38 | 42 ± 31 | 8 | 31 ± 18 | 30 | 45 ± 34 | 0.262 |
SvO2 (%) | 75–85 | 2 | 82 ± 4.2 | 1 | 85 | 1 | 79 | - |
Toxicologic analysis | - | 284 | 111 (39.1%) | 30 | 8 (26.7%) | 254 | 103 (40.6%) | 0.218 |
Parameter | Total Population | Non Survivors | Survivors | p | |||
---|---|---|---|---|---|---|---|
Nb | Result | Nb | Result | Nb | Result | ||
Activated charcoal | 291 | 44 (15.1%) | 30 | 2 (6.7%) | 261 | 42 (16.1%) | 0.172 |
Gastric lavage | 291 | 57 (19.6%) | 30 | 8 (26.7%) | 261 | 49 (18.8%) | 0.302 |
Antidotes | 291 | 60 (20.6%) | 30 | 2 (6.7%) | 261 | 58 (22.2%) | 0.046 |
Mechanical ventilation | 291 | 171 (58.8%) | 30 | 29 (96.7%) | 261 | 142 (54.4%) | 0.000 |
ARDS | 172 | 12 (7%) | 30 | 6 (20%) | 142 | 6 (4.2%) | 0.000 |
MV duration (days) | 171 | 6 ± 8 | 29 | 5 ± 8 | 142 | 6 ± 8 | 0.433 |
Catecholamines | 291 | 78 (26.8%) | 30 | 28 (93.3%) | 261 | 50 (19.2%) | 0.000 |
Renal replacement therapy | 291 | 32 (11%) | 30 | 13 (43.3%) | 261 | 19 (7.3%) | 0.000 |
ECMO | 291 | 3 (1%) | 30 | 2 (6.7%) | 261 | 1 (0.4%) | 0.001 |
Treatment | 291 | 133 (45.7%) | 30 | 20 (66.7%) | 261 | 113 (43.3%) | 0.015 |
Main Toxicants Involved | Related Clinical and Biological Features | |
Benzodiazepines | Coma, aspiration pneumonia | |
Neuroleptics | Coma, respiratory failure, shock, aspiration pneumonia, renal failure, rhabdomyolysis | |
Cardiotrops | Cardiac arrhythmias, shock, heart conduction dysfunction, cardiac arrest, renal failure, elevation in lactate, rhabdomyolysis, liver failure | |
Tricyclic antidepressants | Coma, seizures, shock, heart conduction dysfunction, aspiration pneumonia, renal failure, rhabdomyolysis | |
The Rarest Toxicants in Western Countries | Specific Features | Specific Management |
Herbicides, paraquat | Respiratory failure (acute respiratory distress syndrome), elevation in transaminase, renal failure | No effective antidote |
Rubigine® (Hydrofluoric acid) | Gastrointestinal disturbances (corrosion), dermal injuries, hypocalcemia, metabolic acidosis, respiratory failure, seizures, dysrhythmias, cardiovascular disorders, cardiac arrest | Calcium gluconate, analgesics, hemodialysis, |
Pesticides Organophosphates | Excessive respiratory secretions, and bronchoconstriction, bradycardia, myosis, neuromuscular weakness, seizures, coma, cardiovascular collapse | Atropine, pralidoxime, diazepam |
Star Fruit (Carambola) (Toxin: oxalic acid) | Hiccups, vomiting, encephalopathy, seizures, neuropsychiatric manifestations, acute kidney injury and chronic kidney disease Renal histology: oxalate crystals obstructing the tubules | No effective antidote Renal replacement therapy (hemodialysis or hemoperfusion) |
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Resiere, D.; Kallel, H.; Oxybel, O.; Chabartier, C.; Florentin, J.; Brouste, Y.; Gueye, P.; Megarbane, B.; Mehdaoui, H. Clinical and Epidemiological Characteristics of Severe Acute Adult Poisoning Cases in Martinique: Implicated Toxic Exposures and Their Outcomes. Toxics 2020, 8, 28. https://doi.org/10.3390/toxics8020028
Resiere D, Kallel H, Oxybel O, Chabartier C, Florentin J, Brouste Y, Gueye P, Megarbane B, Mehdaoui H. Clinical and Epidemiological Characteristics of Severe Acute Adult Poisoning Cases in Martinique: Implicated Toxic Exposures and Their Outcomes. Toxics. 2020; 8(2):28. https://doi.org/10.3390/toxics8020028
Chicago/Turabian StyleResiere, Dabor, Hatem Kallel, Odile Oxybel, Cyrille Chabartier, Jonathan Florentin, Yannick Brouste, Papa Gueye, Bruno Megarbane, and Hossein Mehdaoui. 2020. "Clinical and Epidemiological Characteristics of Severe Acute Adult Poisoning Cases in Martinique: Implicated Toxic Exposures and Their Outcomes" Toxics 8, no. 2: 28. https://doi.org/10.3390/toxics8020028