The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

doi:10.5847/wjem.j.1920-8642.2024.022

Abstract

Abstract:

BACKGROUND: In clinical practice, some patients might not be able or unwilling to provide a thorough history of medication and poison exposure. The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.

METHODS: This was a retrospective and descriptive study from an institute of poisoning. Patient registration information and test reports spanning the period from April 1, 2020 to March 31, 2022, were obtained. Patients with uncertain exposure histories and who underwent toxicological analysis were included. Clinical manifestations and categories of toxics were analyzed.

RESULTS: Among the 195 patients with positive toxicological analysis results, the main causes of uncertain exposure history was disturbance of consciousness (62.6%), unawareness (23.6%) and unwillingness or lack of cooperation (13.8%). The predominant clinical manifestations were disturbed consciousness (62.6%), followed by vomiting and nausea (14.4%) and liver function abnormalities (8.7%). A comparison of clinical manifestations between patients with positive and negative (n=99) toxicological analyses results revealed significantly different proportions of disturbances in consciousness (63% vs. 21%), dizziness (1.5% vs. 5.1%), multi-organ failure (1.5% vs. 7.1%), and local pain (0 vs 4%). The main categories of substances involved were psychiatric medications (23.1%), sedatives (20.5%), insecticides (13.8%), and herbicides (12.8%).

CONCLUSION: The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific, and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

Key words: Acute poisoning, Toxic exposure, Toxicological analysis, Clinical manifestation

Qifang Shi, Gen Ba, Zhenyu Xia, Zhengsheng Mao, Hao Sun, Jinsong Zhang. The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning[J]. World Journal of Emergency Medicine, 2024, 15(2): 98-104.

Figures/Tables 5

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Table 1.

Table 2.

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Variables		n (%)
Age, years
	0-17	18 (9.2)
	18-44	65 (33.3)
	45-59	48 (24.6)
	60-74	43 (22.1)
	≥75	21 (10.8)
Gender
	Female	85 (43.6)
	Male	110 (56.4)
Type of exposure
	Suicide	45 (23.1)
	Accident	150 (76.9)
Route of exposure
	Oral	178 (91.3)
	Inhalation	3 (1.5)
	Dermal contact	1 (0.5)
	Unknown	13 (6.7)
Place of residence
	Nanjing	108 (55.4)
	Other cities of Jiangsu Province	80 (41.0)
	Outside of Jiangsu Province	7 (3.6)

Primary clinical manifestations		Positive (n=195)	Negative (n=99)	P-value
Nervous system
	Disturbance of consciousness	122 (62.6)	21 (21.2)	<0.001
	Convulsions	9 (4.6)	2 (2.0)	0.434
	Restlessness	7 (3.6)	0 (0)	0.100
	Dizziness	4 (2.1)	10 (10.1)	0.006
	Headache	3 (1.5)	5 (5.1)	0.171
	Visual disturbances	2 (1.0)	0 (0)	0.552
	Limb numbness	2 (1.0)	0 (0)	0.552
Respiratory system
	Shortness of breath/dyspnea	11 (5.6)	5 (5.1)	0.833
Digestive system
	Nausea and vomiting	28 (14.4)	9 (9.1)	0.198
	Abdominal discomfort/abdomen pain	11 (5.6)	8 (8.1)	0.421
	Diarrhea	1 (0.5)	2 (2.0)	0.548
	Liver dysfunction	17 (8.7)	5 (5.1)	0.259
Circulatory system
	Cardiac arrest	4 (2.1)	2 (2.0)	1.000
	Chest tightness/chest pain	5 (2.6)	4 (4.0)	0.737
	Hypotension	2 (1.0)	1 (1.0)	1.000
	Arrhythmia	0 (0)	1 (1.0)	0.337
Urinary system
	Renal dysfunction	3 (1.5)	6 (6.1)	0.077
Coagulation system
	Coagulation abnormalities	11 (5.6)	6 (6.1)	1.000
Others
	Multi-organ failure	3 (1.5)	7 (7.1)	0.033
	Asthenia	10 (5.1)	6 (6.1)	0.739
	Fever	3 (1.5)	5 (5.1)	0.171
	Skin changes	4 (2.1)	4 (4.0)	0.541
	Local pain	0 (0)	4 (4.0)	0.012
Unrecorded		16 (8.2)	7 (7.1)	-

Categories of drugs and poisons		n (%)
Pesticides
	Herbicides	25 (12.8)
	Insecticides	27 (13.8)
	Rodenticides	11 (5.6)
Drugs
	Psychiatric medications	45 (23.1)
	Sedatives	40 (20.5)
	Drugs for cardiovascular diseases	10 (5.1)
	Nonsteroidal anti-inflammatory drugs	11 (5.6)
	Traditional Chinese Medicine	3 (1.5)
	Others	7 (3.6)
Chemical products
	Alcohols	7 (3.6)
	Organic solvents	4 (2.1)
Heavy metals
	Arsenic	3 (1.5)
	Mercury	1 (0.5)
Toxic gases
	Carbon monoxide	1 (0.5)
Biotoxin
	Belladonna	17 (8.7)
	Toadstool	3 (1.5)
	Others	2 (1.0)
Multiple poisonings		26 (13.3)

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