Traditional Chinese medicine poisoning in the emergency departments in Hong Kong: Trend, clinical presentation and predictors for poor outcome
Rex Pui Kin Lam, Eric Ho Yin Lau, Wai Lam Yip, Joe Kai Shing Leung, Matthew Sik Hon Tsui
Table 1 Clinical presentations of TCM-related toxicities and comparison of patients with any CHM or PCM exposure, n (%)
Variables Total
(n=123)
Involving any CHM
(n=80)
Involving any PCM
(n=45)
P-value
Acute toxicity 96 (78.0) 55 (69.6) 41 (91.1) 0.006a
Nature of poisoning <0.001a
Accidental 14 (11.4) 1 (1.3) 13 (28.9)
Adverse drug reaction 86 (69.9) 78 (97.5) 10 (22.2)
Intentional 23 (18.7) 1 (1.3) 22 (48.9)
Major toxic herbal ingredients involved
Aconitine 18 (14.6) 18 (22.5) 0 (0) 0.001a
Atropine/hyoscyamine/scopolamine 3 (2.4) 3 (3.8) 0 (0) NSb
Cardiac glycosides 4 (3.3) 2 (2.5) 2 (4.4) NSb
Psoralen/isopsoralen 10 (8.1) 9 (11.3) 2 (4.4) NSb
Sophora alkaloids 9 (7.3) 9 (11.3) 0 (0) 0.026b
Methyl salicylate 16 (13.0) 0 (0) 16 (35.6) <0.001a
Anthraquinones 13 (10.6) 12 (15.0) 3 (6.7) NSa
Co-ingestion of Western medicine 14 (11.4) 1 (1.3) 13 (28.9) <0.001a
Time from exposure to symptom onset <0.001a
<1 hour 13 (10.6) 8 (10.0) 5 (11.1)
≥1-4 hours 45 (36.6) 32 (40.0) 13 (28.9)
>4-24 hours 13 (10.6) 12 (15.0) 1 (2.2)
>24 hours 11 (8.9) 11 (13.8) 0 (0)
Not applicable (no symptom) 8 (6.5) 1 (1.3) 7 (15.6)
Unknown 33 (26.8) 16 (20.0) 19 (42.2)
Time from exposure to ED presentation <0.001a
<1 hour 6 (4.9) 1 (1.3) 5 (11.1)
≥1-4 hours 44 (35.8) 21 (26.3) 23 (51.1)
>4-24 hours 32 (26.0) 24 (30.0) 8 (17.8)
>24 hours 28 (22.8) 25 (31.3) 3 (6.7)
Unknown 13 (10.6) 9 (11.3) 6 (13.3)
Triage categories <0.001a
1 (critical) 11 (8.9) 4 (5.0) 7 (15.6)
2 (emergent) 12 (9.8) 5 (6.3) 7 (15.6)
3 (urgent) 65 (52.8) 37 (46.3) 30 (66.7)
4 (semi-urgent) 35 (28.5) 34 (42.5) 1 (2.2)
5 (non-urgent) 0 (0) 0 (0) 0 (0)
PSS, median (IQR) 1.0 ( 1.0-2.0) 2.0 (1.0-2.0) 1.0 (1.0-2.0) 0.002c
Treatments
Gastric lavage 2 (1.6) 0 (0) 2 (4.4) NSb
Activated charcoal 21 (17.0) 3 (3.8) 18 (40.0) <0.001a
Antidote 7 (5.7) 2 (2.5) 5 (11.1) NSb
Electrical therapy 4 (3.2) 3 (3.8) 1 (2.2) NSb
Antiarrhythmic agent 7 (5.7) 7 (8.8) 0 (0) 0.049b
Inotropic support 4 (3.2) 4 (5.0) 0 (0) NSb
Intubation and mechanical ventilation 7 (5.7) 3 (3.8) 4 (8.9) NSb
Renal replacement therapy 4 (3.3) 1 (1.3) 3 (6.7) NSb
Observation ward/emergency medicine ward admission 59 (48.0) 39 (48.8) 20 (44.4) NSa
General ward admission 36 (29.3) 23 (28.7) 15 (33.3) NSa
ICU admission 15 (12.2) 8 (10.0) 7 (15.6) NSa
Median ED length of stay, hours 1.8 (1.0-2.6) 2.0 (1.2-3.1) 1.2 (0.7-2.5) 0.004
Median length of hospitalization, hours, median (IQR) 26.7 (16.9-76.2) 33.1 (17.6-90.9) 23.2 (14.4-71.3 ) NS
Median length of ICU stay, hours, median (IQR) 30.8 (19.1-73.3) 32.8 (19.4-81.4) 30.4 (10.0-73.3) NS
Episode death 1 (0.8) 0 (0) 1 (2.2) NSb
Poor outcome 16 (13.0) 8 (10.0) 8 (17.8) NSa