Causes of hospital admissions for poisoning
Social and economic stresses or mental disorders often result in suicide attempts, particularly through drug overdose, which is one of the most common reasons for emergency hospital admissions. Homicidal poisoning is relatively rare, but surviving victims of this practice are often investigated initially in the hospital environment. Individuals who are administered substances without their knowledge to facilitate robbery or sexual abuse may also be admitted to hospital, although in the latter scenario the victims tend to contact the medical services several days after the incident, so the rape drug (gamma hydroxybutyric acid (GHB), flunitrazepam, alcohol) is no longer detectable. Poisoning in children is mainly accidental, but deliberate poisoning by parents, guardians or siblings does occur. Accidental poisoning usually takes place in the domestic environment, with young children and the elderly particularly at risk. Children may gain access to pharmaceutical products, cleaning agents (bleach, disinfectants), pesticides, alcoholic drinks and cosmetics. The confused elderly may misjudge their intake of medications or be poisoned by inappropriate handling of toxic household products. Both are susceptible to acute or chronic poisoning with carbon monoxide emitted by faulty domestic heating appliances. The workplace is another environment in which accidental poisoning occurs and the analytical results from the hospital laboratory can be important not only in medical diagnosis but also in any subsequent legal investigations that involve insurance claims. On the other hand, the anaesthesiologist wants to know that the poison is not a contraindication for his chosen therapy.
Iatrogenic intoxications occur through inappropriate medical or paramedical treatment. This is an increasing challenge for the toxicologist.
Neonates require intravenous dosing and the need to work out doses per kilogram of body mass introduces the risk that the total amount and volume of medicine to be admin istered may be miscalculated. Other causes of iatrogenic poisoning includedrug interactions, use of the wrong route or speed of administration and failure to take note of impaired liver or renal function, which reduces the patient’s ability to eliminate the drug. A common example is the accumulation of digoxin in elderly patients with reduced renal function.
