Single Center Retrospective Analysis Of Acute Poisoning Cases In The Emergency Department Of Renji Hospital

Single Center Retrospective Analysis of Acute Poisoning Cases in the Emergency Department of Renji HospitalObjectives To conduct a retrospective study in the epidemiological characteristics and treatments of acute poisoning cases in the Emergency Department of Renji hospital in the last 6 years.Methods A total of 1184 cases registered as acute poisoning in the Emergency Department of Renji hospital from January 2011 to December 2016 were enrolled in this study.Clinical data including the demographics,poisoning reasons,poisoning categories and names,route of exposure,monthly and yearly distribution were colleted and analyzed.Among them,80 cases admitted to hospital with detailed documents were further studied,on the clinical features including medical insurance conditions,admission in ICU or not,treatment strategies,hospitalization length,clinical outcome,and hospitalization expense,as well as the general clinical data aforementioned above.Results(1)Among the 1184 acute poisoning cases,male dominated the major compared to female(1.68:1).The median age of the patients was 36(28,52)years old,with a high incidence in the 20-59 year old group(81.25%);the peak incidence age group was 20-29 year old(26.69%).There was 63.43% of the 1184 patients(n=751)were classified as accidentally poisoning and was mainly composed of alcoholic-poisoning male patients,with a median age of 36 years old.There was a significant increase in the accidentally poisoning cases during the last 3 years.Nearly 14.36% of the 1184 patients(n=170)committed suicide by taking pesticide,drug or chemical products,with a median age of 42.5 years old,and most of them were female.The difference of the sex ratio between the accidentally poisoning and suicide-commiting was statistically significant(P =0.000).The main route of exposure to poison was by gastrointestinal tract(99.49%).The major poisoning categories were alcohol(56.07%),drugs(28.50%),pesticide(9.70%).Hypnotics(19.23%)ranked first in medicinal poisoning,while paraquat(34.78%)and organophosphorus pesticide(23.48%)occupied the top two categories in the pesticide poisoning.There was an increased incidence in alcohol abuse,which was mainly conducted by men(80.75%)and mostly happened in January,with a median age of 35 years old.While there was a decreased incidence of pesticide poisoning,which was mainly conducted by women(56.52%)and mostly occurred in summer season,with a median age of 36 years old.There were more women(64.8%)intoxicated in drug poisoning,with a median age of 38 years old.(2)Among the 80 hospitalized patients,there were less men than women(male:female was 1:1.22),the average age was 45.50±20.34 years old,with a high incidence in the stage of 20-59 years old(68.75%);the highest incidence age group was 20-29 years old(20.00%).The main poisoning categories were pesticides(43.75%)and drugs(40.00%).The median hospitalization days of pesticide poisoning patients was 8 days,and most of these patients were without social medical insurance.Paraquat(45.71%)and organophosphorus pesticide(42.86%)were the most common in the pesticide poisoning.While the median hospitalization days of drug poisoning patients was 7.5 days,and most of these patients had basic medical insurance.Hypnotics(50.00%)ranked the first place in the drug poisoning.About 68.75% of the 80 hospitalized patients were admitted to intensive care unit,and most of them were pesticide or drug poisoning.While the rest of them were admitted to ward.Among the 80 hospitalized patients,the pesticide poisoning patients were more often to accept extracorporeal treatments(14.29%)than others,while the patients who were pesticide or drug toxication were more often to accept mechanical ventilation treatment(8.57%、15.63% repectively)than others.The age(OR=0.848,P=0.021)and hospitalization length(OR=0.844,P=0.049)were two protective factors of clinical outcome.The hospitalization expense increased with the growth of age(β=0.230,P=0.010)and hospitalization length(β=0.647,P=0.000),whether admitted to ICU or not(β=-0.211,P=0.026)and whether accepting extracorporeal treatments or not(β=-0.234,P=0.010)would also have a matter with hospitalization expense.Conclusions The demographic composition of acute poisoning cases registered in the emergency department of Renji Hospital was mainly young and middle-aged male patients,and mostly attributed to alcohol abuse,drug and pesticide intoxication.The age and hospitalization length were two flencing factors of clinical outcomes.The hospitalization expense increased pararelled with the growth of age,hospitalization length,admission to ICU or accepting extracorporeal treatments.Successful Treatment with Etanercept for Poison-induced Liver Injury : A Report of Three CasesIntroduction Acute poisoning could result in hepatic injury characterized by progressive aggravated organ failure with life threatening.Case Report We reviewed three cases of poison-induced liver injury with gastrointestinal disorder on admission,two cases poisoned by mushroom α-Amanitin while the other one poisoned by overdose of acetaminophen.They were recovered after the treatments with Etanercept and traditional supportive therapies under the close monitor of clinicians by changes in symptoms and laboratory examinations.Discussion There is a lack of effective and safety treatments for poison-induced liver injury.TNF-α has been proved to play an important role in the aggravation of liver injury.The blocker of TNF-α showed traces to reduce the damage of inflammatory to organs,which still needs more evidence.The Epidemiological Characteristics and Treatments for Acute PosoningAcute poisoning is characterized by sudden occurrence,rapid change and high mortality.The epidemiological characteristics of acute poisoning vary from country to country.The main treatment strategies include vomiting,gastric lavage,activated charcoal,cathartics,whole bowel irrigation,diuresis,extracorporeal treatments,oxygen therapy and hyperbaric oxygen therapy,mechanical ventilation and specific antidote.We need to pay more attention to evidence-based medical therapy of acute poisoning,to reduce the mortality and improve the outcomes of these emergency conditions.