Physiol. Res. 68 (Suppl. 1): S31-S38, 2019 https://doi.org/10.33549/physiolres.934321 Acute Medication Poisoning Causing Hospital Admissions in Childhood: a 3-Year Prospective Observational Single-Center Study P. MATALOVÁ1, M. PORUBA1, M. WAWRUCH2, P. ONDRA3, K. URBÁNEK1 1Department of Pharmacology, Faculty of Medicine and Dentistry, Palacký University in Olomouc, Czech Republic, 2Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia, 3Department of Forensic Medicine and Medical Law, Faculty of Medicine and Dentistry, Palacký University in Olomouc, Czech Republic Received June 17, 2019 Accepted July 4, 2019 Summary Introduction Although the risks of medication poisoning in children are often reported, there is a lack of studies addressing this issue. The Medication poisoning is one of the serious majority of papers deal with a wide range of xenobiotics health-related risks in children. Prevention is of major poisoning and, in particular, alcohol intoxications. All hospital importance, where simple precautions can prevent many admissions during three years were prospectively recorded. serious but avoidable cases (Meyer et al. 2007). Patients younger than 19 years of age admitted for acute drug According to the data from the Toxicological Information intoxications were further evaluated. A total of 15,069 children Center (TIC) in Prague, Czech Republic, the largest were admitted. Of them, 55 were hospitalized for acute proportion of all poisonings is caused by medications. medication poisoning. The condition was more common in girls The age of one to three years old carries the highest risk (72.7 % vs. 27.3 %, p<0.01). Toddlers were the largest patient with a wide occurrence of noxae which can cause long- group (36.4 %). Non-steroidal anti-inflammatory drugs (NSAIDs) lasting damage. Motor skills are already well developed were the most frequently used agents, with ibuprofen being the in children of this age; however, they are still unable to leading drug (20 % of all cases). The route of intoxication was rationally recognize dangerous situations. Drug almost exclusively oral. Solid drug forms were involved in intoxications (both by OTC and prescription medications) 40 (72.7 %) cases. There was one fatal accidental poisoning. The at this age are purely accidental, and any serious highest occurrence of accidental drug intoxications was in the complications are rare (Rakovcová 2013, Pawłowicz age group from one to three years. Attempted suicides were et al. 2013, Sahin et al. 2011, Bates et al. 1997). In 2012, most frequent among adolescents. We are currently actively the TIC assessed 5,840 toddlers between the ages of one dealing with the issue. The cohort has been expanded to include to three years, i.e. 72 % of all queries in the age group up a period of ten years and is being analyzed. to 18 years. Certain number of sudden poisonings occurs even among younger children. In the first six months of Key words age, these are mainly caused by parents. Other causes are Medication poisoning • Drug intoxications • Children • accidental, for instance spillage of liquid drugs over the Adolescents face, nose or mouth (Rakovcová 2013, Mühlendahl et al. 2003). By contrast, in adolescents, in the cases of Corresponding author attempted suicides, poisonings can either be fatal or cause K. Urbánek, Department of Pharmacology, Faculty of Medicine long-lasting damage. In those cases, very toxic drugs are and Dentistry, Palacký University in Olomouc, Hněvotínská 3, frequently used found by those individuals in home Olomouc, 775 15, Czech Republic. Fax: 00420 585 632 552. medicine cabinets; these are often medications taken by E-mail: [email protected] grandparents (Bentur et al. 2010). PHYSIOLOGICAL RESEARCH • ISSN 0862-8408 (print) • ISSN 1802-9973 (online) 2019 Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic Fax +420 241 062 164, e-mail: [email protected], www.biomed.cas.cz/physiolres S32 Matalová et al. Vol. 68 As for errors and accidents associated with Ethics approval misadministration of prescribed drugs, the victim The study was approved by the Local Institutional commonly is a very young child. Those cases can involve Research Ethics Committee [No. 1236/04 S-IV]. situations of accidental swap of medications or of their inappropriate use and dosage. Another cause can be Methods wrong understanding of the recommended dosage; also, it is not uncommon for different family members to All admissions to the Department of Pediatrics give separate doses independently from one another (DP) of the University Hospital Olomouc, Czech (Rakovcová 2013). Republic, including surgical cases and hospitalizations A whole range of medicines can cause serious for specialized diagnostic purposes were screened in the intoxications. A substantial risk is associated with electronic Hospital Information System. The study period cardiovascular medications, particularly calcium channel was from January 1, 2010 to December 31, 2012. All blockers, beta blockers, and digoxin. Other known patients aged 18 years and younger possibly admitted causing agents are tricyclic antidepressants and because of acute pharmaceutical drug intoxications, both carbamazepine, oral antidiabetics, antihistamines, and intentional and unintentional, were further evaluated. drugs containing iron ions. Cases in which parents Patients who were admitted because of adverse drug unintentionally combine several anti-inflammatory agents reactions caused by usual therapeutic doses or because of containing paracetamol are also common. Moreover, intoxication by alcohol, “street” drugs, chemical parents often underestimate the toxic properties of compounds, poisonous plants, food or other noxious paracetamol due to its presence in many easily available agents were excluded from the study. over-the-counter drugs (Mund et al. 2015, Peden 2008). The study was conducted following the Increasingly used slow release drug formulations which guidelines of the Declaration of Helsinki. All data were usually contain larger amounts of the active compound processed anonymously. can lead to unpredictable clinical course of intoxication Admissions were assessed in the hospital (Rakovcová 2013). information system on a daily basis. The study team Although the risks of medication poisoning in collected the following information from the case notes: children are often reported in the literature, there have not age, sex, the substance and its formulation, source of the been many studies addressing this issue. The majority of agent, causes of poisoning, presenting complaint and papers published in this field deal with a wide range of clinical symptoms on admission, the length of hospital xenobiotics poisoning and, in particular, alcohol stay, and information on patient’s condition at discharge. intoxication. Studies describing the occurrence of The results of toxicological analysis including medication poisonings leading to hospitalizations, detection of toxic agents in blood, urine and/or gastric however, are rather rare, limited to unintentional content, and measurements of plasma levels of the poisonings (Hoy et al. 1999) or specific type of medicinal substances were also evaluated. The following methods products like opioids (Gaither et al. 2016). Although were used at the Department of Forensic Medicine and some earlier studies have brought interesting results, the Medical Law for toxicology analysis: fluorescence spectrum of drugs used is changing quite rapidly. polarization immunoassay (FPIA), thin layer Therefore, we consider it useful to complement the study chromatography (TLC), gas chromatography-mass specifically addressing intoxications caused by medicinal spectrometry (GC-MS), gas chromatography with products, in particular because of the identification of the electron capture detector (GC-ECD), and high- risks of individual types of medicines. performance liquid chromatography (HPLC). Continuous data were expressed as mean ± Aim of the study standard deviation, while categorical variables as The aim of this study was to evaluate the frequency and percentage. prevalence, causes, and outcomes of medication poisonings leading to hospital admission in children over Results a three-year period in the University Hospital in Olomouc, Czech Republic. Over the study period, a total of 15,069 children and adolescents were admitted to the DP. Of them, 55 were 2019 Medication Poisoning Causing Hospital Admissions in Children S33 hospitalized for (suspected) acute medication intoxication, than in boys (72.7 % vs. 27.3 %, p<0.01). Toddlers were which accounts for 0.36 % of all patient admissions to the the largest patient group (36.4 %), followed by DP. None of the intoxicated patients was admitted schoolchildren (27.3 %), and adolescents (14.5 %). In the repeatedly during the study period for the same reason. two oldest age groups (i.e. children ≥ 12 years), girls In general, poisoning was more common in girls prevailed significantly (Table 1). Table 1. Distribution of the patients hospitalized for acute drug intoxication according to the age and sex. Number of patients Female Male Age group Age (%) (%) (%) Newborns 0-28 d 0 (0) 0 (0) 0 (0) Infants 29-364 d 6 (10.9) 4 (7.3) 2 (3.6) Toddlers 1-3 y 20 (36.4) 11 (20) 9 (16.4) Preschoolers 3-6 y 4 (7.3) 4 (7.3) 0 (0) Early school age children 6-11 y 2 (3.6) 0 (0) 2 (3.6) Schoolchildren 11-15 y 15 (27.3) 13 (23.6) 2 (3.6) Adolescents 15-19 y 8 (14.5) 8 (14.5) 0 (0) Total 0-19