Assessing the poisoning cases being monitored in the ICU in terms of causes and mortality

Introduction

The Medline investigations carried out in recent years demonstrate that morbidity and mortality caused by acute poisoning are higher in elderly patients, suicidal attempts and multiple drug intakes [1].

Method

We retrospectively studied a total of 121 poisoning cases that were monitored in our ICU between January 2002 and July 2005 in terms of causes and mortality.

Results

Of the subjects, 55 were poisoned by organophosphates, 18 by multiple drugs, 18 by tricyclic antidepressant (TCA), and 11 dead patients the mean age, APACHE II score, and times of mechanic ventilation (TMV) were higher compared with the discharged group and their Glasgow Coma Scores (GCS) at admittance were found significantly reduced from those discharged (Table 1). While 56 patients were directly admitted to our hospital, 65 patients were referred. Although there was no statistical significance in APACHE II scores of those who were referred, their TMV and length of stay in the ICU were found statistically significant. It was determined that the rate of female patients who subjected to multiple medicines and TCA poisoning was higher and they were younger than other groups. Mortality was 21.8% in the organophosphate group, 5.6% in the multiple poisoning group, 0% in the TCA group and 54.5% in the methanol group. APACHE II scores were found significantly higher in the methanol group compared with the other four groups. A considerably prolonged TMV was detected in the organophosphate group than in the multiple drug poisoning and TCA groups. Three of the patients in the multiple drug poisoning group were those who received antidepressive treatment previously. Four of the patients in the organophosphate group had received cardiopulmonary resuscitation where they transferred and three of these patients were lost during observation in our ICU. Three of the patients in the organic phosphate group accidentally took poison (one through inhalation and two through foods) and all other poisoning cases were intentional suicide attempts except the methanol and food poisoning cases.

Table 1

Discussion

It was established in the epidemiology study of two acute poisoning cases reported in Spain that the suicide attempts related to depressive disorders were predominant in women and the mortality was high despite advanced life support and antidote therapy being provided [2]. In our study, old age, lower GCS at admittance and prolonged admittance time were considered factors affecting mortality in terms of overall poisoning. Interestingly, the majority of the patients in the multiple and TCA poisonings with suicidal intention were younger women who received antidepressive treatment.