Differences in treatment advice for common poisons by poisons centres - An international comparison

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 45; no. 3; pp. 234 - 239
• Main Authors: Good, Alison M., Kelly, Catherine A., Bateman, D. Nicholas
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Taylor & Francis 01.01.2007
• Subjects: Acetaminophen; Acetaminophen - poisoning; Antidotes - administration & dosage; Biological and medical sciences; Charcoal - administration & dosage; Decontamination - methods; Emergency Treatment - methods; Epidemiology. Vaccinations; Gastric Lavage; General aspects; Gut decontamination; Humans; Infectious diseases; Intensive care medicine. Antipoison centers; International Cooperation; Ipecac - administration & dosage; Medical sciences; Poison Control Centers; Poisoning - therapy; Poisons Centres; Surveys and Questionnaires; Toxicology; Sri Lanka; Germany; Human; Poisons Centres; Gut decontamination; Digestive system; Drug intoxication; Recommendation; Paracetamol; Treatment; Antipoison center; Acetaminophen; Therapeutic protocol; Comparative study; International
• ISSN: 1556-3650; 1556-9519
• DOI: 10.1080/15563650601031601

Objective. To investigate how poisons centres advise on management of common drug poisonings and compare advice on gut decontamination with the EAPCCT/AACT Position Statements. Methods. An interactive questionnaire was sent to 14 poisons centres asking about working practices, "top 20" enquiries in 2002, and management of 4 specific drug poisonings. Results. Replies were received from centres in 11 countries. Annual telephone enquiry numbers varied from 620 (Sri Lanka) to over 50,000 (Germany for 2000). Recommendations for gut decontamination for acetaminophen poisoning were: activated charcoal (AC) alone (5 centres); gastric lavage (GL) alone ( ); AC and/or GL ( ); AC, GL and/or ipecac ( ). Only 40% (4/10) recommended AC and 50% (3/6) GL within 1 hour. Intervention doses for gut decontamination ranged from 100-200 mg/kg (nine centres) and for "high-risk" groups 75-100 mg/kg ( ). Plasma concentration for N-acetylcysteine (NAC) treatment ranged from 150 mg/L (four centres) to 200 mg/L ( ) at 4 hours. Results were similarly varied for three other common drug poisons (benzodiazepines, amitriptyline, and paroxetine). Conclusions. Most poisons centres have protocols that differ in terms of gut decontamination, timing, and intervention doses. Many centres recommend charcoal or gastric lavage after the 1-hour limit proposed in the Position Statements. There is scope for rationalization of approaches to the management of common poisons.