Basic & Clinical Pharmacology & Toxicology, 2019
IntroductionThe prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin... more IntroductionThe prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin is still considered the “gold standard” and is, therefore, increasingly prescribed. Monitoring of metformin continues to be debated because of its association with lactic acidosis (MALA), a rare but life‐threatening complication. The aim of this study was to identify the main individual characteristics associated with severe poisoning in self‐poisonings and therapeutic accidents reported at the Western France Poison Control Centre (PCC).MethodsRetrospective study of metformin poisoning from September 1999 to September 2016 at the Western France PCC recorded in the French PCC’s database (SICAP). The end‐point was clinically high severity (mortality and/or cardiovascular shock and/or GCS ≤ 7/15).ResultsOf the 382 cases included, 197 concerned acute accidental exposures, 127 self‐poisonings and 58 therapeutic accidents. MALA concerned 63 patients: 44 therapeutic accidents and 19 self‐poiso...
Introduction: Sulcotrione is a herbicidal agent belonging to the family of triketones. Sulcotrion... more Introduction: Sulcotrione is a herbicidal agent belonging to the family of triketones. Sulcotrione herbicides are used for weed control in maize and flax crops. To date, no cases of human poisoning had been reported in the literature linked to different herbicidal agents in the triketone family. We report here on two cases of the voluntary ingestion of this substance in the form of the branded product MikadoTM, which were recorded by the Angers Poison Centre. Case report: Both cases of voluntary ingestion constituted attempted suicide, and involved two men aged 30 and 37 years. Their symptoms linked to sulcotrione were limited to vomiting, despite elevated plasma concentrations of sulcotrione. In one case, hypertyrosinemia has been demonstrated. The outcome was favourable in both patients and at follow up, no ocular disorders were observed. In the second case, hypotension and transient renal failure could be linked to the concomitant ingestion of chlorophenoxy herbicides. Discussion...
National audienceEn toxicologie clinique, la gradation des cas d'envenimations vipérine néces... more National audienceEn toxicologie clinique, la gradation des cas d'envenimations vipérine nécessite une expertise accrue. Pour répondreà ces besoins, un système clinique d'aideà la décision aété initié reposant sur un moteur d'inférence par les règles. L'utilisation de celui-ci nécessite une réponse exhaustivè a toutes les entrées du système, ne prend pas en compte l'incertitude et possède un questionnement fixe et non adapté aux réponses de l'utilisateur. Nous avons initié le développement d'un réseau bayésien, capable de reproduire la logique clinique et offrant des résultats similaires au système actuel. Nous nous sommes appuyées sur une méthode de construction mixte. Nous avons testé le système en condition d'entrées exhaustives pour mesurer la performance du modèle et observé une technique d'ordonnancement des questions basé sur la maximisation de l'information mutuelle entre les variables d'entrées et la sortie du réseau. En comparant ...
Objective The purpose of this study is to describe cases of quetiapine poisoning and identify pot... more Objective The purpose of this study is to describe cases of quetiapine poisoning and identify potential risk factors that increase the severity of the cases. Methods A retrospective study of self-poisoning with quetiapine as reported by the western France PCC between 2007 and 2017. Results Three hundred and seventy-two cases of quetiapine poisoning. Circumstances are known in 367 of 372 cases. There were 75 cases of “null severity” (grade 0), 133 cases of “mild severity” (grade 1), 85 cases of “moderate severity” (grade 2) and 79 cases of “high severity” (grade 3). Five deaths were listed in this series. The most commonly observed symptoms were neurological and cardiovascular in nature (drowsiness, coma, tachycardia, hypotension). Of these cases, 79.8% included voluntary ingestions. Among 302 cases with coagents, the most common coagents were benzodiazepines (56%), other psychotropic drugs (41%) and antidepressants (37%). An evaluated ingested dose ≥ 1500 mg and the number of coagents ≥ 2, increase the risk of severe poisoning. In particular, concomitant ingestion of benzodiazepines and antidepressants with quetiapine were associated with high severity (OR: 2.478 [1.3–4.723]) and (OR: 1.820 [1.010–3.316]). Discussion Quetiapine is a relatively new atypical antipsychotic with fewer side effects [1] . It is increasingly prescribed to patients [2] . Quetiapine may lead to severe poisoning for which there is currently no specific treatment. It is important to monitor the symptoms, particularly with atypical antipsychotics, even though they are considered safer than the first generation [3] . Patients and practitioners should be aware of this when quetiapine is prescribed, particularly when used in combination with other medications, and in order to deal with cases of poisoning. Conclusion Because of the particular profile of the patients on quetiapine, it seems important to be vigilant with regard to the dosages administered and the therapeutic schemes proposed to the patients. The recommendations err on the side of caution, especially when used in cases of major depression, associated with other therapies.
Clinical toxicology (Philadelphia, Pa.), Jan 8, 2018
Accidental inoculation of humans with veterinary vaccines can lead to early and late complication... more Accidental inoculation of humans with veterinary vaccines can lead to early and late complications. The aim of our study is to describe these complications and their risk factors. Prospective observational study conducted from 2007 to 2014 at Angers University Hospital's Poison Control Centre. The endpoints examined were: early and late locoregional complications, surgical treatment, and absence from work. The statistical analysis was based on a multivariate analysis. The presence of mineral oil adjuvants, the injection of the vaccine under pressure and injection in joint and tendon of the hand significantly increased early locoregional complications and surgery but only the presence of mineral oil adjuvant increased significantly late locoregional complications at one month. Absence from work is significantly correlated to the site of injection and the presence of mineral oil adjuvant. It is important to know about the contents of the veterinary vaccine in order to anticipate e...
Basic & Clinical Pharmacology & Toxicology, 2019
IntroductionThe prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin... more IntroductionThe prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin is still considered the “gold standard” and is, therefore, increasingly prescribed. Monitoring of metformin continues to be debated because of its association with lactic acidosis (MALA), a rare but life‐threatening complication. The aim of this study was to identify the main individual characteristics associated with severe poisoning in self‐poisonings and therapeutic accidents reported at the Western France Poison Control Centre (PCC).MethodsRetrospective study of metformin poisoning from September 1999 to September 2016 at the Western France PCC recorded in the French PCC’s database (SICAP). The end‐point was clinically high severity (mortality and/or cardiovascular shock and/or GCS ≤ 7/15).ResultsOf the 382 cases included, 197 concerned acute accidental exposures, 127 self‐poisonings and 58 therapeutic accidents. MALA concerned 63 patients: 44 therapeutic accidents and 19 self‐poiso...
Introduction: Sulcotrione is a herbicidal agent belonging to the family of triketones. Sulcotrion... more Introduction: Sulcotrione is a herbicidal agent belonging to the family of triketones. Sulcotrione herbicides are used for weed control in maize and flax crops. To date, no cases of human poisoning had been reported in the literature linked to different herbicidal agents in the triketone family. We report here on two cases of the voluntary ingestion of this substance in the form of the branded product MikadoTM, which were recorded by the Angers Poison Centre. Case report: Both cases of voluntary ingestion constituted attempted suicide, and involved two men aged 30 and 37 years. Their symptoms linked to sulcotrione were limited to vomiting, despite elevated plasma concentrations of sulcotrione. In one case, hypertyrosinemia has been demonstrated. The outcome was favourable in both patients and at follow up, no ocular disorders were observed. In the second case, hypotension and transient renal failure could be linked to the concomitant ingestion of chlorophenoxy herbicides. Discussion...
National audienceEn toxicologie clinique, la gradation des cas d'envenimations vipérine néces... more National audienceEn toxicologie clinique, la gradation des cas d'envenimations vipérine nécessite une expertise accrue. Pour répondreà ces besoins, un système clinique d'aideà la décision aété initié reposant sur un moteur d'inférence par les règles. L'utilisation de celui-ci nécessite une réponse exhaustivè a toutes les entrées du système, ne prend pas en compte l'incertitude et possède un questionnement fixe et non adapté aux réponses de l'utilisateur. Nous avons initié le développement d'un réseau bayésien, capable de reproduire la logique clinique et offrant des résultats similaires au système actuel. Nous nous sommes appuyées sur une méthode de construction mixte. Nous avons testé le système en condition d'entrées exhaustives pour mesurer la performance du modèle et observé une technique d'ordonnancement des questions basé sur la maximisation de l'information mutuelle entre les variables d'entrées et la sortie du réseau. En comparant ...
Objective The purpose of this study is to describe cases of quetiapine poisoning and identify pot... more Objective The purpose of this study is to describe cases of quetiapine poisoning and identify potential risk factors that increase the severity of the cases. Methods A retrospective study of self-poisoning with quetiapine as reported by the western France PCC between 2007 and 2017. Results Three hundred and seventy-two cases of quetiapine poisoning. Circumstances are known in 367 of 372 cases. There were 75 cases of “null severity” (grade 0), 133 cases of “mild severity” (grade 1), 85 cases of “moderate severity” (grade 2) and 79 cases of “high severity” (grade 3). Five deaths were listed in this series. The most commonly observed symptoms were neurological and cardiovascular in nature (drowsiness, coma, tachycardia, hypotension). Of these cases, 79.8% included voluntary ingestions. Among 302 cases with coagents, the most common coagents were benzodiazepines (56%), other psychotropic drugs (41%) and antidepressants (37%). An evaluated ingested dose ≥ 1500 mg and the number of coagents ≥ 2, increase the risk of severe poisoning. In particular, concomitant ingestion of benzodiazepines and antidepressants with quetiapine were associated with high severity (OR: 2.478 [1.3–4.723]) and (OR: 1.820 [1.010–3.316]). Discussion Quetiapine is a relatively new atypical antipsychotic with fewer side effects [1] . It is increasingly prescribed to patients [2] . Quetiapine may lead to severe poisoning for which there is currently no specific treatment. It is important to monitor the symptoms, particularly with atypical antipsychotics, even though they are considered safer than the first generation [3] . Patients and practitioners should be aware of this when quetiapine is prescribed, particularly when used in combination with other medications, and in order to deal with cases of poisoning. Conclusion Because of the particular profile of the patients on quetiapine, it seems important to be vigilant with regard to the dosages administered and the therapeutic schemes proposed to the patients. The recommendations err on the side of caution, especially when used in cases of major depression, associated with other therapies.
Clinical toxicology (Philadelphia, Pa.), Jan 8, 2018
Accidental inoculation of humans with veterinary vaccines can lead to early and late complication... more Accidental inoculation of humans with veterinary vaccines can lead to early and late complications. The aim of our study is to describe these complications and their risk factors. Prospective observational study conducted from 2007 to 2014 at Angers University Hospital's Poison Control Centre. The endpoints examined were: early and late locoregional complications, surgical treatment, and absence from work. The statistical analysis was based on a multivariate analysis. The presence of mineral oil adjuvants, the injection of the vaccine under pressure and injection in joint and tendon of the hand significantly increased early locoregional complications and surgery but only the presence of mineral oil adjuvant increased significantly late locoregional complications at one month. Absence from work is significantly correlated to the site of injection and the presence of mineral oil adjuvant. It is important to know about the contents of the veterinary vaccine in order to anticipate e...
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