Latest Articles and News - Jun 19, 2025
post on 19 Jun 2025
Mixed drug overdose involving clonazepam, alprazolam, and olanzapine in a 72-year-old male with Parkinson's disease: a case report.
This case report discusses a 72-year-old male patient with Parkinson's disease, depression, and somatization disorder, presenting to the emergency department after a suspected overdose of clonazepam. The patient was discovered unconscious approximately 2.5 h after ingestion of over 30 tablets of clonazepam, in combination with an overdose of alprazolam and olanzapine. Despite initial challenges with gastric lavage, subsequent treatment involved supportive care, management of complications such as pneumonia, and renal replacement therapy, ultimately leading to recovery. This case highlights the complexities of managing overdoses, particularly those involving drugs with long half-lives, and highlights the challenges of treating elderly patients and the importance of supportive care in recovery.
https://pubmed.ncbi.nlm.nih.gov/40535968/Variations in Poisoning Epidemiology and Management During the Initial COVID-19 Outbreak in a Taiwanese Emergency Department.
The COVID-19 pandemic significantly impacted the epidemiology of emergency department (ED) presentations, including those for self-harm and poisoning. Taiwan, with its strict border controls and quarantine measures, experienced a delayed COVID-19 outbreak in late April 2022. We evaluated epidemiological changes in ED poisoning cases and assessed whether their management was affected during the early stages of the COVID-19 outbreak. We conducted a retrospective cohort study of ED poisoning cases during the early phase of the COVID-19 outbreak (May 1-July 31, 2022) and the corresponding pre-COVID-19 periods (May 1-July 31, 2018, and 2019) at a tertiary medical center. Demographic data, poisoning characteristics, treatment efficiency, and clinical outcomes were compared between the two periods. In total, 145 poisoning cases (48.3 per month) were identified during the pandemic, compared to 572 (95.3 per month) in the pre-pandemic period. Poisoned patients were significantly older (median age: 48 vs 40.5 years, p = 0.009) during the pandemic compared to the pre-pandemic periods, with a significant decline in pediatric poisoning cases. Although an increase in prescription drug exposures and a slight decrease in other poisoning categories was observed, these differences were not statistically significant. The proportion of severe poisoning cases (poisoning severity score 3 or 4) was significantly higher during the pandemic than in the pre-pandemic period (14.5% vs 7.9%, p = 0.021), and was accompanied by increased rates of intubation and intensive care unit admissions. ED stays were significantly prolonged during the pandemic, particularly among patients at risk of concurrent COVID-19 infection. Mortality rates remained comparable between the two periods. The epidemiology, disease severity, and management efficiency of poisoning cases were significantly affected during the early phase of the nationwide COVID-19 outbreak. Further large-scale studies are needed to validate these findings and inform future interventions.
https://pubmed.ncbi.nlm.nih.gov/40535710/Puncture frequency, coagulopathy, and liver injury as independent risk factors for bleeding in acute diquat poisoning after enhanced blood purification therapy.
To identify independent risk factors for bleeding and propose preventive strategies in acute diquat poisoning (ADP) patients undergoing enhanced blood purification therapy (EBPT). In this retrospective study, a total of 297 ADP patients (May 2022-April 2024) were categorized into a conventional treatment (n=124) and EBPT (n=173) groups according to their treatment regimens. Clinical data, coagulation/liver function, and bleeding events were compared between the two groups. Logistics regression analysis was applied to identify independent risk factors for bleeding. COX regression model was used to explore the risk factors affecting survival prognosis. Kaplan-Meier method was used to draw survival analysis curve. The EBPT group had a significantly higher bleeding incidence (45.05% vs. 4.23%, P<0.05), predominantly at puncture sites. Independent bleeding risk factors included puncture frequency, degree of poisoning, prolonged prothrombin time (PT), activated partial thromboplastin time (APTT), white blood cell count (WBC), elevated alanine aminotransferase (ALT), and aspartate aminotransferase (AST) (P<0.05). Bleeding patients had a higher 28-day mortality rate (50.00% vs. 18.95%, P<0.05) and longer ICU stays. Cox analysis confirmed that ALT, puncture frequency, poisoning severity, and bleeding were significant survival predictors (P<0.05). EBPT increases bleeding risk in ADP patients, mainly due to procedural factors and organ dysfunction. Optimizing puncture techniques and closely monitoring coagulation and liver function may improve patient outcomes.
https://pubmed.ncbi.nlm.nih.gov/40535647/Transforming Opioid Overdose Prevention in the United States: Leveraging FDA's Narcan Approval to Foster a Culture of Health.
The opioid crisis in the United States remains a major public health emergency, claiming over 100,000 lives annually, with potent synthetic opioids like fentanyl driving the surge in overdose deaths. In response, the US Food and Drug Administration's (FDA) approval of over-the-counter (OTC) Narcan represents a pivotal step toward expanding access to naloxone, a life-saving medication that reverses opioid overdoses. However, maximizing the public health impact of this measure requires more than increasing availability-it demands a comprehensive, systemic approach that fosters community engagement, advances harm reduction, and transforms healthcare delivery. This paper applies the Robert Wood Johnson Foundation's (RWJF) Culture of Health (COH) model to provide a structured framework for optimizing Narcan's impact. Through its four interconnected pillars, (1) making health a shared value, (2) fostering cross-sector collaboration, (3) ensuring equitable access, and (4) transforming healthcare systems, the COH model offers critical insights into building sustainable, community-wide overdose prevention strategies. Central to this effort is stigma reduction, as negative perceptions of opioid use disorder continue to undermine both public willingness to seek naloxone and healthcare providers' readiness to offer it. Within the COH framework, the paper examines evidence-based interventions that normalize naloxone use, innovative cross-sector partnerships that foster acceptance, and policy initiatives that expand access while addressing systemic inequities. By synthesizing real-world success stories, including community-based naloxone distribution programs, law enforcement-assisted interventions, and hospital-based harm reduction initiatives, this paper outlines a strategic blueprint for translating the FDA's Narcan ruling into lasting public health outcomes. It concludes with actionable recommendations for healthcare systems, policymakers, and public health agencies to institutionalize harm reduction practices and dismantle barriers to care. Only by embedding a Culture of Health into the fabric of healthcare, public health, and community systems can we achieve lasting progress against the opioid crisis and foster healthier, more equitable communities.
https://pubmed.ncbi.nlm.nih.gov/40535536/Rise in deaths from drug overdose and firearm injury during coronavirus disease 2019 pandemic and its impact on organ transplantation.
The coronavirus disease 2019 (COVID-19) pandemic had a profound societal impact in the United States which was associated with a decrease in overall life expectancy and an increase in substance abuse and firearm injury. Our understanding of changes in mortality trends during the pandemic and its effect on organ availability for transplantation is limited. To examine the trends of substance abuse and firearm injury fatalities during COVID-19 and a potential correlation with organ transplantation. Crude rates of population-based deaths among adults (18-75 years) from firearm injury and substance abuse from the period of 2014-2021 were obtained from centers of disease control wide-ranging online data for epidemiologic research database. Crude rates of causes of donor (18-75 years) deaths from 2014-2021 were obtained from the united network for organ sharing database. Average annual percentage change (AAPC) deaths among the United States population were 16.4% from substance abuse and 3.4% from firearm injury. AAPC in cause of death among organ donors was 10.9% from drug intoxication and 2.1% from firearm injury. There was a significant (P < 0.001) and progressive increase in mortality from both causes during the pandemic (2020-2021) and significant correlation (P < 0.001) between population and donor causes of death. COVID-19 exacerbated trends in substance abuse and firearm mortality with a consequent increase in organ donation from donors who died from these two causes. Identifying the socioeconomic and regional disparities associated with increase in deaths from substance abuse and firearms can help guide post-pandemic healthcare policies and mitigate their impact on organ transplantation.
https://pubmed.ncbi.nlm.nih.gov/40535492/Poisoning due to medication dosing errors in Spain.
Dosage errors are a common mechanism of poisoning in childhood. The aim of this study was to analyze the characteristics and management of poisoning secondary to dosage errors in pediatric emergency departments (EDs) in Spain. Study based on a prospective register of poisonings documented in 58 Spanish EDs participating in the Toxicology Surveillance Observatory of the Spanish Society of Paediatric Emergency Medicine (SEUP) between 2008 and 2023. The register documented 3429 episodes of exposure to toxic substances, of which 289 (8.4%) were medication dosing errors, with a vast majority occurring in the home setting. Seventy-eight (27.0%) occurred in children aged less than 1 year (amounting to 37.9% of poisonings in this age group and 85.0% of poisonings in infants aged less than 3 mo). Overall, the most commonly involved medications were antipyretics/analgesics (35.6%, mainly paracetamol), with significant differences depending on patient age. Forty-nine of the patients (17.0%) were symptomatic, 118 (41.8%) underwent additional testing, 83 (28.7%) received treatment, and 115 (39.8%) were admitted to the ED observation unit or to hospital. All had favorable outcomes. Medication dosing errors constitute an important mechanism of poisoning, especially in children aged less than 1 year, leading to a significant number of interventions in EDs. Preventive measures aimed at educating families to avoid these poisonings should be considered.
https://pubmed.ncbi.nlm.nih.gov/40533289/
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