Does determination of drug level in intoxicated patients offer an advantage in diagnosis, treatment, and reducing complications?

• Published in: Journal of the Pakistan Medical Association Vol. 70; no. 5; p. 825
• Main Authors: Tayfur, Ismail, Senel, Ahmet, Colak, Sahin, Ibrahim, Abdullah, Afacan, Mustafa Ahmet, Saritas, Ayhan
• Format: Journal Article
• Language: English
• Published: Pakistan Knowledge Bylanes 01-05-2020
• Subjects: Adult; Antidepressants; Blood tests; Care and treatment; Diagnosis; Drug toxicity; Drug-Related Side Effects and Adverse Reactions - blood; Drug-Related Side Effects and Adverse Reactions - etiology; Drug-Related Side Effects and Adverse Reactions - mortality; Drug-Related Side Effects and Adverse Reactions - therapy; Early Medical Intervention - standards; Emergency Medical Services - methods; Emergency Medical Services - statistics & numerical data; Emergency medicine; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Male; Methods; Mortality; Needs Assessment; Pharmaceutical Preparations - blood; Poisoning; Substance Abuse Detection - methods; Substance Abuse Detection - statistics & numerical data; Suicide, Attempted - prevention & control; Suicide, Attempted - statistics & numerical data; Time-to-Treatment; Toxicity; Tranquilizing agents; Tricyclic antidepressants; Turkey; Intoxication, Plasma toxic doses, Eergency, Drug levels
• DOI: 10.5455/JPMA.7631
• ISSN: 0030-9982

To investigate the effect of determining the drug type and level on emergency management in patients presenting with intoxication, and to identify the factors behind associated mortality.
The retrospective, observational, cross-sectional and single centre study was conducted at a large tertiary care teaching hospital in Istanbul, Turkey, between September and November 2016 using the hospital's toxicology registry. Data was extracted for patients who had presented to the emergency department from January 1, 2011, to February 28, 2013, and were found to have toxic doses of single active ingredients in the plasma. The patients were evaluated in terms of age, gender, demographic characteristics, time from ingestion to presentation, reason for drug ingestion, type of drug ingested, time elapsed before the emergency service was called, treatment given, drug level, hospitalisation and mortality. Data was analysed using SPSS 11.5.
Of the 224 patients, 145(64.8%) were women. The overall mean age was 30.8±15.4 years. Drug ingestion was more common in women aged 18-30 years (p<0.0001). Besides, 215(96%) patients had ingested drugs with the intent to commit suicide. The minimum education level of 163(72.8%) patients was high school. The most frequently ingested drug was paracetamol 90(40.2%). Overall mortality was 4(1.8%) and all of them were brought to the emergency department after a delay of more than five hours (p<0.0001).
Drug type and quantity were found to be of great importance in taking timely decisions while attending to patients with intoxication in an emergency setting. Delay in presentation was associated with mortality..