Dr LAM Sin Man, Grace, Pamela Youde Nethersole Eastern Hospital, November 2008
Abstract
Background: Poisoning is a significant cause of morbidity and mortality worldwide and occasionally requires intensive care treatments. This study was performed to describe the pattern of poisoning, as well as the clinical characteristics and outcomes of patients who required admission to a local intensive care unit.
Methods: Patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital for poisoning from January 2000 to May 2008 were included. Excluded were chronic alcoholics or drug addicts with significant head injury, and carbon monoxide poisoning in fire victims. Outcomes included duration of mechanical ventilation, lengths of intensive care unit and acute hospital stay, and death.
Results: A total of 265 admissions were analyzed. Benzodiazepine (25.3%), alcohol (23%), tricyclic antidepressant (17.4%), and carbon monoxide (15.1%) were the four commonest poisons encountered. Patients were mostly young and previously healthy adults admitted after attempting suicides. A significant proportion had psychiatric illness. Intubation was required in 67.9% of admissions, and two patients with carbon monoxide poisoning were treated with hyperbaric oxygen therapy. Complication such as impaired consciousness was commonly encountered in 65.3%, but mortality was infrequent (3.0%), and the median lengths of stay in the intensive care unit and hospital were less than one and three days respectively. Independent predictors of a longer stay included age of 65 or older, presence of comorbid disease, APACHE II score of 25 or greater, and development of shock, rhabdomyolysis, and aspiration pneumonia, while alcohol intoxication was an independent predictor of a shorter stay.
Conclusions: Benzodiazepines, alcohol, TCA, and CO were the four commonest poisons encountered in our ICU from 2000 to May 2008. Acute complications, especially altered mental status were common, but mortality was infrequent. Most patients were discharged from the intensive care unit and hospital after a short stay.
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