[Fatal cases of poisoning in eastern Denmark during a five-year period (1998-2002)].
Sys Stybe JohansenChristina JacobsenIrene MüllerHenning Willads PetersenKirsten Wiese SimonsenBirgitte KringsholmAnni Steentoft
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Abstract:
The goal of this investigation was to determine the pattern of fatal poisonings in eastern Denmark from 1998 to 2002 and compare it with similar investigations from 1979 to 1996.The material included 2,996 autopsies from eastern Denmark in which extensive forensic chemical investigations were performed.Of the 2,996 autopsies, 694 cases were drug addicts, in whom 497 fatal overdoses were detected, while in the remaining 2,302 cases of nonaddicts, 443 fatal poisonings were determined. Morphine (heroine) and methadone were the main causes of death among the fatal poisonings of the drug addicts, accounting for 90% of the cases. The fatal poisonings among the nonaddicts were due mainly to medicine (73% of the cases); 13% were due to carbon monoxide and/or cyanide poisoning, and 12% were due to acute ethanol poisoning. The medicine was a wide range of strong and weak analgesics, antidepressants and antipsychotic drugs of older and newer origins. Comparison with earlier investigations from 1979 to 1996 showed that the poisoning pattern had changed, but similarities were also seen. The most frequently occurring drugs involved in fatal poisonings in eastern Denmark from 1979 to 2002 were morphine, methadone, ethanol and carbon monoxide/cyanide, of which methadone increased in occurrence over the 23-year period.The investigation of fatal poisonings is an important element in monitoring changes in drug abuse and poisoning patterns and levels.Cite
Background
In Finland, post-mortem toxicology is performed in 13% of all deceased as part of medico-legal cause-of-death investigation. Of all toxicology cases, approximately every 6th case is determined by a forensic pathologist to be a fatal poisoning. Medicinal and illegal drugs form the biggest group of intoxicants causing fatal poisonings.Methods
All fatal drug poisoning cases in 2013 were examined in terms of toxicological findings, background information and the manner of death. In these cases, comprehensive post-mortem toxicology had been performed by using chromatographic and mass spectrometric techniques in an accredited central laboratory serving the whole country.Results
There were 476 fatal poisonings by medicinal and illegal drugs in 2013. Buprenorphine, tramadol, pregabalin, codeine, oxycodone, amitriptyline, quetiapine, paracetamol, venlafaxine and insulin were the ten most prevalent major factors in the cause of death. The most common manner of death in all drug poisonings was suicide (41%, median age 49), followed by unintentional poisoning (40%, median age 37), and unknown manner of death (18%, median age 51). Unintentional poisoning was the most common manner of death in opioid poisonings, especially with the strong opioids possessing high abuse potential. In cases involving antipsychotics and antidepressants, such as quetiapine, amitriptyline and venlafaxine, as well as with insulin, the percentage of suicide was higher than that of unintentional poisoning.Conclusions
Information on fatal poisonings reveals trends in drug use, which can help monitor adverse effects of medicines as well as the emergence of new abused substances. The extensive post-mortem toxicology data collected in the cause-of-death investigations in Finland enable reliable statistical analysis and research on a population-based level.Propoxyphene
Forensic Toxicology
Drug overdose
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Analysis of acute drug poisonings was made using materials available at the Saint Petersburg Toxicological Center for the period of 10 years. The indicated poisonings became two times more frequent and in 1989 accounted for 76% of the total number of intoxications. Poisonings with tranquilizers ranked first in frequency, then followed antihistamine drugs, neuroleptics and hypnotics. There was an increase in the percentage of hemiton poisonings, which turned out lethal in 1.6-3% of cases. In most cases, the drugs were taken to commit suicide, more rarely they were used to have or to potentiate the effects of alcoholic euphoria. Among women, poisonings were encountered three times more often than among men.
Euphoriant
Saint petersburg
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Stimulant
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This paper describes 170 cases of acute poisoning in 60 men and 110 women admitted to emergency room from January through November 1999. Ninety-eight percent of acute poisonings were self-inflicted, and 90% occurred at home. Drugs were used in 134 (79%) suicide attempts. Eighty-one acute poisonings were caused by benzodiazepines (48%) and 19 by antidepressants (11%). Alcohol intoxication, alone or combined with the intake of psychoactive drug (28 cases, 16%) predominated in men. Cocaine was the most common narcotic drug, taken by 31 patients (16%). Other acute poisonings involved ecstasy (4 cases), CO (6 cases), and HCl inhalation (2 cases). Previous suicide attempts due to depression were found in 68 patients (40%). Fifty patients (29%) were comatose on admission, 24 were transferred to intensive care, and 3 died. Data such as these can be very useful for handling self-inflicted acute poisonings and for planning long-term health care activities.
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Depression
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Buprenorphine is a µ-partial agonist and k-antagonist acting on central opioid receptors. Patented for analgesia in 1968, buprenorphine has been used as opioid substitutive therapy since the 1990s, as well as methadone. The aim was to document pediatric poisoning, to discover the severity, and to evaluate the treatment with naloxone. All pediatric poisonings reported to the poison control center Marseille (France)-from January 1, 2009 to December 31, 2018-were included. Analysis put value on gender, age, estimated quantity, symptoms and their delay, place of treatment, medical treatment, utilization of antidotes, severity of intoxications, and patients' outcome. Fifty-four infant poisonings with buprenorphine were recorded, doses varied between 1 and 36 mg, and children showed mainly neurological (somnolence, miosis…) and gastroenteric (vomiting) effects. Pulmonary effects were described for four children. According to the poisoning severity score, 8 intoxications were classified as 'no symptoms or signs', 37 as minor poisonings, 3 as moderate, none as severe or fatal and 6 were unknown. Medical care was required for 46 children, and four of them were treated with naloxone. Buprenorphine poisoning can cause neurological, gastroenteric, and respiratory symptoms. Even licking a tablet leads to intoxication because of maximal tablet's absorption while placing it under the tongue. Hospital admission is necessary even at small doses. Naloxone was efficient in the four described cases. Parents have to be aware of the poisoning risk with buprenorphine. Recently, commercialized instantly dissolving formulations could cause more severe intoxications.
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Somnolence
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A total of 1558 admissions to an ICU over 5 years because of severe self-poisoning with drugs provides the basis for this study. Three drugs accounted for 60% of the admissions: overdose with barbiturates in 28%, with tricyclic antidepressants in 19% and with propoxyphene in 14%. The annual incidence of poisonings with barbiturates and tricyclic antidepressants was the same during the period, whereas the incidence of propoxyphene intoxication increased by 80%. Intensive supportive care was the main principle of treatment. All patients were artificially ventilated. The mortality rate was 6.1%, salicylate, propoxyphene and strong analgesics having the highest mortalities (11%, 9% and 9%, respectively). A mortality rate of 3% was found following overdose with tricyclic antidepressants. By 36 months after the overdose, 235 patients (18%) had died. The expected number of deaths was 39 (3%). The suicide rate in the follow-up period was 10%, in the majority (75%) of whom death was caused by a new episode of self-poisoning.
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Drug overdose
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This paper presents the results of a preliminary analysis of deaths from acute poisoning, which occurred in the Department of Toxicology in Poznań in 2008-2012. During this period, recorded 31 cases of fatal poisoning, representing 0.38% of all treated cases. In subsequent years the percentage of poisoning deaths ranged from 0.25 to 0.49%. Throughout the period leading cause of fatal poisoning were drugs (38.71%) and non-consumptive alcohols (methanol or ethylene glycol) (38.71%). In subsequent years, however, a decrease in the percentage of drug poisoning (from 75 to 0%) and an increase in the percentage of nonconsumptive alcohol poisoning (from 0% to 100%) were observed. In fatal cases were diagnosed among others olanzapine, carbamazepine, pseudoephedrine, tramadol, benzodiazepines, clozapine, morphine and benzodiazepines, insulin, verapamil, carbon monoxide and smoke fire, cyanide, Amanita phalloides, ethanol and a mixture of drugs with ethanol poisoning. The most common fatal poisoning occurred in people addicted (45.16%), mainly in alcohol dependence syndrome (35.48%). Suicidal poisoning was the cause of 32.26% of the deaths, while accidental of 19.35%. In nine cases, the procedure of diagnosis of death from irreversible cessation of brain stem function was performed in order to qualify donors of organs for transplantation or to terminate the therapy. One of the dead was liver and kidneys, and two were kidneys donors.
Amanita phalloides
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Citalopram
Nitrazepam
Drug overdose
Propoxyphene
Zopiclone
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Acute non-lethal poisonings with drugs within the period of 10 years according to archives data of Toxicological center and medicolegal department of victims' examination in Leningrad medicolegal expert Bureau were analysed. Number of drug poisoning cases increased two-fold and formed 76% of all poisoning cases. Tranquilizers, then antihistaminic, neuroleptic and hypotensive (clofelin) agents were used most often. Drugs were taken with suicidal attempt or with the aim of getting "alcoholic" effect. Poisonings among women were registered three times more often than among men.
Information center
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