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Toxicovigilance II: A survey of the spectrum of acute poisoning and current practices in the initial management of poisoning cases admitted to South African hospitals

Denise Joy H Veale, Cherylynn Angela Wium, Gert Jacobus Müller

Abstract


Background. Initial management of acute poisoning in South African (SA) hospitals such as gastric decontamination and use of antidotes has not been evaluated relevant to current international guidelines.

Objectives. The objective of this study was to conduct a toxicovigilance survey of SA hospital admissions to assess the spectrum of acute poisonings, current practices in gastric decontamination, and use of antidotes in the management of acute poisoning.

Methods. A survey was undertaken based on acute poisoning admissions to Tygerberg Academic Hospital (TAH) as well as hospital-based poisoning consultations with the Tygerberg Poison Information Centre (TPIC) over 1 year to investigate trends in admissions and the initial management of hospital admissions for acute poisoning. TAH admission details and TPIC consultation forms for hospital-based cases were analysed for patient demographics, causes of poisoning, gastric decontamination measures and use of antidotes.

Results. There were 662 admissions to TAH and 2 459 hospital-based TPIC consultations. Paracetamol and cholinesterase inhibitors were the most common exposures in both studies. Gastric decontamination measures were employed at TAH in 47.7% of cases and in 5.3% of hospital cases reported to the TPIC. Of these, 67.4% in the TAH study and 26.1% in the TPIC study did not comply with international guidelines. N-acetylcysteine was administered inappropriately in 22.1% of the paracetamol poisoning cases at TAH and in 1.6% in the TPIC study. Atropine was administered unnecessarily in 12 of 30 TPIC cases.

Conclusion. This study has identified the need for directed training on gastric decontamination measures and use of antidotes and, combined with the previous study, has identified national trends in poisoning.

Authors' affiliations

Denise Joy H Veale, Tygerberg Poison Information Centre, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Parow, Cape Town

Cherylynn Angela Wium, Tygerberg Poison Information Centre, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Parow, Cape Town

Gert Jacobus Müller, Tygerberg Poison Information Centre, Department of Medicine, Faculty of Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Parow, Cape Town

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Keywords

acute poisoning, hospital admissions; poison information centre; toxicovigilance; gastric decontamination; paracetamol; N-acetylcysteine; cholinesterase-inhibitors; atropine

Cite this article

South African Medical Journal 2013;103(5):298-303. DOI:10.7196/SAMJ.6648

Article History

Date submitted: 2012-12-18
Date published: 2012-12-31

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