Skip to main content
Top
Published in: BMC Emergency Medicine 1/2015

Open Access 01-12-2015 | Research article

Patients presenting with acute poisoning to an outpatient emergency clinic: a one-year observational study in Oslo, Norway

Authors: Odd Martin Vallersnes, Dag Jacobsen, Øivind Ekeberg, Mette Brekke

Published in: BMC Emergency Medicine | Issue 1/2015

Login to get access

Abstract

Background

In Oslo, the majority of patients with acute poisoning are treated in primary care, at an emergency outpatient clinic with limited diagnostic and treatment resources. We describe the poisonings currently seen in this setting. We compare our findings with previous studies, with special concern for the appearance of new toxic agents, and changes in overall numbers and patterns of poisoning.

Methods

Observational study. Patients above the age of 12 years presenting at Oslo Accident and Emergency Outpatient Clinic (Oslo Legevakt) with acute poisoning were included consecutively from October 2011 through September 2012. Physicians and nurses registered data on preset forms. Main outcome measures were toxic agents, age, sex, intention, referral and time of presentation.

Results

There were 2923 episodes of acute poisoning in 2261 patients. Median age of the patients was 32 years, and 1430 (63 %) were males. The most frequent toxic agents were ethanol in 1684 (58 %) episodes, heroin in 542 (19 %), benzodiazepines in 521 (18 %), amphetamine in 275 (9 %), fire smoke in 192 (7 %), gamma-hydroxybutyrate (GHB) in 144 (5 %), and cannabis in 143 (5 %). In 904 (31 %) poisonings there were more than one toxic agent. In 493 episodes (17 %), the patient was hospitalised, and in 60 episodes (2 %) admitted to a psychiatric ward. Most poisonings, 2328 (80 %), were accidental overdoses with substances of abuse, 276 (9 %) were suicide attempts, and 312 (11 %) were accidents. Among ethanol poisonings in patients above the age of 26 years, 685/934 (73 %) were in males, and 339/934 (36 %) presented during weekends. However, among ethanol poisonings in patients under the age of 26 years, 221/451 (49 %) were in females, and 297/451 (66 %) presented during weekends.

Conclusions

The poisonings treated in this primary care setting were mostly due to accidental overdoses with ethanol or other substances of abuse. There is a disconcerting weekend drinking pattern among adolescents and young adults, with young females presenting as often as young males with ethanol poisoning.
Literature
1.
go back to reference Bjornaas MA, Jacobsen D, Haldorsen T, Ekeberg O. Mortality and causes of death after hospital-treated self-poisoning in Oslo: a 20-year follow-up. Clin Toxicol. 2009;47:116–23.CrossRef Bjornaas MA, Jacobsen D, Haldorsen T, Ekeberg O. Mortality and causes of death after hospital-treated self-poisoning in Oslo: a 20-year follow-up. Clin Toxicol. 2009;47:116–23.CrossRef
2.
go back to reference Wood DM, Greene SL, Dargan PI. Five-year trends in self-reported recreational drugs associated with presentation to a UK emergency department with suspected drug-related toxicity. Eur J Emerg Med. 2013;20:263–7.CrossRefPubMed Wood DM, Greene SL, Dargan PI. Five-year trends in self-reported recreational drugs associated with presentation to a UK emergency department with suspected drug-related toxicity. Eur J Emerg Med. 2013;20:263–7.CrossRefPubMed
3.
go back to reference Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol. 2012;8:15–32.CrossRefPubMedPubMedCentral Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol. 2012;8:15–32.CrossRefPubMedPubMedCentral
4.
go back to reference Haberkern M, Exadaktylos AK, Marty H. Alcohol intoxication at a university hospital acute medicine unit--with special consideration of young adults: an 8-year observational study from Switzerland. Emerg Med J. 2010;27:199–202.CrossRefPubMed Haberkern M, Exadaktylos AK, Marty H. Alcohol intoxication at a university hospital acute medicine unit--with special consideration of young adults: an 8-year observational study from Switzerland. Emerg Med J. 2010;27:199–202.CrossRefPubMed
6.
go back to reference Knudsen K, Greter J, Verdicchio M. High mortality rates among GHB abusers in Western Sweden. Clin Toxicol. 2008;46:187–92.CrossRef Knudsen K, Greter J, Verdicchio M. High mortality rates among GHB abusers in Western Sweden. Clin Toxicol. 2008;46:187–92.CrossRef
7.
go back to reference Vallersnes OM, Lund C, Duns AK, Netland H, Rasmussen IA. Epidemic of poisoning caused by scopolamine disguised as Rohypnol tablets. Clin Toxicol. 2009;47:889–93.CrossRef Vallersnes OM, Lund C, Duns AK, Netland H, Rasmussen IA. Epidemic of poisoning caused by scopolamine disguised as Rohypnol tablets. Clin Toxicol. 2009;47:889–93.CrossRef
8.
go back to reference Vevelstad M, Oiestad EL, Middelkoop G, Hasvold I, Lilleng P, Delaveris GJ, et al. The PMMA epidemic in Norway: comparison of fatal and non-fatal intoxications. Forensic Sci Int. 2012;219:151–7.CrossRefPubMed Vevelstad M, Oiestad EL, Middelkoop G, Hasvold I, Lilleng P, Delaveris GJ, et al. The PMMA epidemic in Norway: comparison of fatal and non-fatal intoxications. Forensic Sci Int. 2012;219:151–7.CrossRefPubMed
9.
go back to reference Lund C, Vallersnes OM, Jacobsen D, Ekeberg O, Hovda KE. Outpatient treatment of acute poisonings in Oslo: poisoning pattern, factors associated with hospitalization, and mortality. Scand J Trauma Resusc Emerg Med. 2012;20:1.CrossRefPubMedPubMedCentral Lund C, Vallersnes OM, Jacobsen D, Ekeberg O, Hovda KE. Outpatient treatment of acute poisonings in Oslo: poisoning pattern, factors associated with hospitalization, and mortality. Scand J Trauma Resusc Emerg Med. 2012;20:1.CrossRefPubMedPubMedCentral
10.
go back to reference Heyerdahl F, Hovda KE, Bjornaas MA, Nore AK, Figueiredo JC, Ekeberg O, et al. Pre-hospital treatment of acute poisonings in Oslo. BMC Emerg Med. 2008;8:15.CrossRefPubMedPubMedCentral Heyerdahl F, Hovda KE, Bjornaas MA, Nore AK, Figueiredo JC, Ekeberg O, et al. Pre-hospital treatment of acute poisonings in Oslo. BMC Emerg Med. 2008;8:15.CrossRefPubMedPubMedCentral
11.
go back to reference Bjornaas MA, Bekken AS, Ojlert A, Haldorsen T, Jacobsen D, Rostrup M, et al. A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo. BMC Psychiatry. 2008;8:8.CrossRefPubMedPubMedCentral Bjornaas MA, Bekken AS, Ojlert A, Haldorsen T, Jacobsen D, Rostrup M, et al. A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo. BMC Psychiatry. 2008;8:8.CrossRefPubMedPubMedCentral
12.
go back to reference Bargagli AM, Hickman M, Davoli M, Perucci CA, Schifano P, Buster M, et al. Drug-related mortality and its impact on adult mortality in eight European countries. Eur J Public Health. 2006;16:198–202.CrossRefPubMed Bargagli AM, Hickman M, Davoli M, Perucci CA, Schifano P, Buster M, et al. Drug-related mortality and its impact on adult mortality in eight European countries. Eur J Public Health. 2006;16:198–202.CrossRefPubMed
13.
go back to reference Heyerdahl F, Bjornaas MA, Dahl R, Hovda KE, Nore AK, Ekeberg O, et al. Repetition of acute poisoning in Oslo: 1-year prospective study. Br J Psychiatry. 2009;194:73–9.CrossRefPubMed Heyerdahl F, Bjornaas MA, Dahl R, Hovda KE, Nore AK, Ekeberg O, et al. Repetition of acute poisoning in Oslo: 1-year prospective study. Br J Psychiatry. 2009;194:73–9.CrossRefPubMed
14.
go back to reference Bjornaas MA, Hovda KE, Heyerdahl F, Skog K, Drottning P, Opdahl A, et al. Suicidal intention, psychosocial factors and referral to further treatment: a one-year cross-sectional study of self-poisoning. BMC Psychiatry. 2010;10:58.CrossRefPubMedPubMedCentral Bjornaas MA, Hovda KE, Heyerdahl F, Skog K, Drottning P, Opdahl A, et al. Suicidal intention, psychosocial factors and referral to further treatment: a one-year cross-sectional study of self-poisoning. BMC Psychiatry. 2010;10:58.CrossRefPubMedPubMedCentral
15.
go back to reference Lund C, Teige B, Drottning P, Stiksrud B, Rui TO, Lyngra M, et al. A one-year observational study of all hospitalized and fatal acute poisonings in Oslo: epidemiology, intention and follow-up. BMC Public Health. 2012;12:858.CrossRefPubMedPubMedCentral Lund C, Teige B, Drottning P, Stiksrud B, Rui TO, Lyngra M, et al. A one-year observational study of all hospitalized and fatal acute poisonings in Oslo: epidemiology, intention and follow-up. BMC Public Health. 2012;12:858.CrossRefPubMedPubMedCentral
16.
go back to reference Cook S, Moeschler O, Michaud K, Yersin B. Acute opiate overdose: characteristics of 190 consecutive cases. Addiction. 1998;93:1559–65.CrossRefPubMed Cook S, Moeschler O, Michaud K, Yersin B. Acute opiate overdose: characteristics of 190 consecutive cases. Addiction. 1998;93:1559–65.CrossRefPubMed
17.
go back to reference Bennewith O, Peters TJ, Hawton K, House A, Gunnell D. Factors associated with the non-assessment of self-harm patients attending an Accident and Emergency Department: results of a national study. J Affect Disord. 2005;89:91–7.CrossRefPubMed Bennewith O, Peters TJ, Hawton K, House A, Gunnell D. Factors associated with the non-assessment of self-harm patients attending an Accident and Emergency Department: results of a national study. J Affect Disord. 2005;89:91–7.CrossRefPubMed
18.
go back to reference Bjornaas MA, Teige B, Hovda KE, Ekeberg O, Heyerdahl F, Jacobsen D. Fatal poisonings in Oslo: a one-year observational study. BMC Emerg Med. 2010;10:13.CrossRefPubMedPubMedCentral Bjornaas MA, Teige B, Hovda KE, Ekeberg O, Heyerdahl F, Jacobsen D. Fatal poisonings in Oslo: a one-year observational study. BMC Emerg Med. 2010;10:13.CrossRefPubMedPubMedCentral
20.
go back to reference Johansen IH, Morken T, Hunskaar S. Contacts related to psychiatry and substance abuse in Norwegian casualty clinics. A cross-sectional study. Scand J Prim Health Care. 2009;27:180–5.CrossRefPubMedPubMedCentral Johansen IH, Morken T, Hunskaar S. Contacts related to psychiatry and substance abuse in Norwegian casualty clinics. A cross-sectional study. Scand J Prim Health Care. 2009;27:180–5.CrossRefPubMedPubMedCentral
22.
go back to reference Holzer BM, Minder CE, Schatti G, Rosset N, Battegay E, Muller S, et al. Ten-year trends in intoxications and requests for emergency ambulance service. Prehospital Emerg Care. 2012;16:497–504.CrossRef Holzer BM, Minder CE, Schatti G, Rosset N, Battegay E, Muller S, et al. Ten-year trends in intoxications and requests for emergency ambulance service. Prehospital Emerg Care. 2012;16:497–504.CrossRef
23.
go back to reference Kuzelova M, Hararova A, Ondriasova E, Wawruch M, Riedel R, Benedekova M, et al. Alcohol intoxication requiring hospital admission in children and adolescents: retrospective analysis at the University Children's Hospital in the Slovak Republic. Clin Toxicol. 2009;47:556–61.CrossRef Kuzelova M, Hararova A, Ondriasova E, Wawruch M, Riedel R, Benedekova M, et al. Alcohol intoxication requiring hospital admission in children and adolescents: retrospective analysis at the University Children's Hospital in the Slovak Republic. Clin Toxicol. 2009;47:556–61.CrossRef
24.
go back to reference Hallgren M, Leifman H, Andreasson S. Drinking less but greater harm: could polarized drinking habits explain the divergence between alcohol consumption and harms among youth? Alcohol Alcohol. 2012;47:581–90.CrossRefPubMed Hallgren M, Leifman H, Andreasson S. Drinking less but greater harm: could polarized drinking habits explain the divergence between alcohol consumption and harms among youth? Alcohol Alcohol. 2012;47:581–90.CrossRefPubMed
25.
go back to reference Stolle M, Sack PM, Thomasius R. Binge drinking in childhood and adolescence: epidemiology, consequences, and interventions. Dtsch Arztebl Int. 2009;106:323–8.PubMedPubMedCentral Stolle M, Sack PM, Thomasius R. Binge drinking in childhood and adolescence: epidemiology, consequences, and interventions. Dtsch Arztebl Int. 2009;106:323–8.PubMedPubMedCentral
29.
go back to reference Herbeck DM, Brecht ML, Lovinger K, Raihan A, Christou D, Sheaff P. Poly-drug and marijuana use among adults who primarily used methamphetamine. J Psychoactive Drugs. 2013;45:132–40.CrossRefPubMed Herbeck DM, Brecht ML, Lovinger K, Raihan A, Christou D, Sheaff P. Poly-drug and marijuana use among adults who primarily used methamphetamine. J Psychoactive Drugs. 2013;45:132–40.CrossRefPubMed
30.
go back to reference Gjersing L, Jonassen KV, Biong S, Ravndal E, Waal H, Bramness JG, et al. Diversity in causes and characteristics of drug-induced deaths in an urban setting. Scand J Public Health. 2013;41:119–25.CrossRefPubMedPubMedCentral Gjersing L, Jonassen KV, Biong S, Ravndal E, Waal H, Bramness JG, et al. Diversity in causes and characteristics of drug-induced deaths in an urban setting. Scand J Public Health. 2013;41:119–25.CrossRefPubMedPubMedCentral
31.
go back to reference D'Onofrio G, Becker B, Woolard RH. The impact of alcohol, tobacco, and other drug use and abuse in the emergency department. Emerg Med Clin North Am. 2006;24:925–67.CrossRefPubMed D'Onofrio G, Becker B, Woolard RH. The impact of alcohol, tobacco, and other drug use and abuse in the emergency department. Emerg Med Clin North Am. 2006;24:925–67.CrossRefPubMed
32.
go back to reference Crawford MJ, Patton R, Touquet R, Drummond C, Byford S, Barrett B, et al. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet. 2004;364:1334–9.CrossRefPubMed Crawford MJ, Patton R, Touquet R, Drummond C, Byford S, Barrett B, et al. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet. 2004;364:1334–9.CrossRefPubMed
Metadata
Title
Patients presenting with acute poisoning to an outpatient emergency clinic: a one-year observational study in Oslo, Norway
Authors
Odd Martin Vallersnes
Dag Jacobsen
Øivind Ekeberg
Mette Brekke
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2015
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-015-0045-2

Other articles of this Issue 1/2015

BMC Emergency Medicine 1/2015 Go to the issue