Toxicovigilance. II: A survey of the spectrum of acute poisoning and current practices in the initial management of poisoning cases admitted to South African hospitals.

BACKGROUND: Initial management of acute poisoning in South African (SA) hospitals such as gastric decontamination and use of antidotes has not been evaluated relevant to current international guidelines.

OBJECTIVES: The objective of this study was to conduct a toxicovigilance survey of SA hospital admissions to assess the spectrum of acute poisonings, current practices in gastric decontamination, and use of antidotes in the management of acute poisoning.

METHODS: A survey was undertaken based on acute poisoning admissions to Tygerberg Academic Hospital (TAH) as well as hospital-based poisoning consultations with the Tygerberg Poison Information Centre (TPIC) over 1 year to investigate trends in admissions and the initial management of hospital admissions for acute poisoning. TAH admission details and TPIC consultation forms for hospital-based cases were analysed for patient demographics, causes of poisoning, gastric decontamination measures and use of antidotes.

RESULTS: There were 662 admissions to TAH and 2 459 hospital-based TPIC consultations. Paracetamol and cholinesterase inhibitors were the most common exposures in both studies. Gastric decontamination measures were employed at TAH in 47.7% of cases and in 5.3% of hospital cases reported to the TPIC. Of these, 67.4% in the TAH study and 26.1% in the TPIC study did not comply with international guidelines. N-acetylcysteine was administered inappropriately in 22.1% of the paracetamol poisoning cases at TAH and in 1.6% in the TPIC study. Atropine was administered unnecessarily in 12 of 30 TPIC cases.

CONCLUSION: This study has identified the need for directed training on gastric decontamination measures and use of antidotes and, combined with the previous study, has identified national trends in poisoning.