The National Poisons Information Service is an information service commissioned by Public Health England on behalf of the UK health departments. Poisoning accounts for 1% of NHS admissions. Pesticides used in agriculture (particularly organophosphorus insecticides) are extremely toxic, but 87% of around 120,000 annual poisoning cases in the UK take place in the home..
The management of patients suspected, but not confirmed, as being poisoned is challenging. The Royal College of Emergency Medicine and National Poisons Information Service have produced this guidance to provide a generalised clinical approach to any poisoned patient in the emergency department. This guideline provides a clinical approach to support the initial assessment of a patient, identification of potential toxic agents and emergency management. A toxidromic approach is used, with emphasis on consideration of the toxicokinetics of potential poisons and how the patient's clinical condition may change. It does not replace poison-specific guidance available from TOXBASE and the NPIS or a locally appropriate poisons centre.
OBJECTIVE:Colchicine, derived from autumn crocus (Colchicum autumnale), has been used for centuries to treat arthritis. Currently, colchicine is licensed in the UK for the treatment of gout and familial Mediterranean fever. Off-label uses include pericarditis and potentially acute coronary syndrome and coronary artery disease. This study was performed to characterise colchicine poisoning in children in the UK. DESIGN:A retrospective analysis of telephone enquiries regarding colchicine to the National Poisons Information Service (NPIS) recorded in the UK Poisons Information Database (UKPID). SETTING:All UKPID data on colchicine poisoning between 2011 and 2021. PATIENTS:All patients less than 18 years old with colchicine exposure where telephone advice was sought from NPIS. MAIN OUTCOME MEASURES:The contemporaneous demographics, epidemiology, morbidity, mortality and dose ingested (if available). RESULTS:Over the decade, 57 cases (median age 7 years, range 0-17 years) were reported to NPIS, yielding a minimum incidence of 0.41 cases/million children/year. Outcome data were available in 13/57 (23%) cases. Around half, 30 (52%) were symptomatic at presentation, with gastrointestinal disturbance being the most common symptom in 22 cases (39%). 12 patients (21.1%) progressed to systemic toxicity, with 7 (12%) suffering multiple organ failure and there were 4 deaths (7%). Estimated ingested doses ranged from 0.01 mg/kg to 1.45 mg/kg. Fatalities occurred at doses of between 0.21 to 1.45 mg/kg; all were mixed overdoses. CONCLUSIONS:Colchicine overdose in children is infrequent but can be fatal. Colchicine poisoning in children can present asymptomatically and progress to systemic toxicity. Paediatricians should be aware of the potential severity of toxicity from colchicine overdose.
AIMS:Propranolol is licensed in the UK and elsewhere to relieve symptoms of anxiety. In overdose, propranolol poisoning can be serious, difficult to treat and potentially fatal. This paper describes cases of intentional propranolol overdose reported to the UK National Poisons Information Service in order to raise awareness of the risk of harm following propranolol overdose and support safer prescribing. METHODS:This study reviews enquiries to UK Poison Centres involving intentional overdoses of propranolol requiring hospital attendance and reported between 1 January 2022 and 31 December 2023. RESULTS:There were 444 enquiries about 363 intentional propranolol overdoses in 359 different patients (248 [69%] women). Median age [interquartile range, IQR] was 32 [22-45] years (n = 355); 52 (14%) patients were <18 years old. The indication was known in 121 (33%) cases, and was anxiety in 111. In 43/61 cases where propranolol and an antidepressant were co-prescribed, patients took both in overdose. The outcome was confirmed in 159 (44%) exposures; 110 patients recovered completely, 13 had ongoing features, one had permanent sequelae, and 35 died. CONCLUSIONS:Overdose patients were often prescribed propranolol for anxiety, and many developed systemic toxicity. Despite intensive treatment, many patients still die from poisoning with propranolol alone or in combination with other agents. Given the dangers of propranolol in overdose, prescribers based in primary care settings should recognize that using propranolol to manage anxiety can be dangerous.
