John S. Fountain

Comparison of the Fatal Toxicity Index of Zopiclone with Benzodiazepines

Abstract Background. Zopiclone is a hypnosedative structurally unrelated to the benzodiazepines but operating at the same receptor complex. Although zopiclone has been used in clinical practice for many years, relatively little is known of its relative toxicity in comparison with other hypnosedatives. Method. Deaths, where hypnosedatives were implicated, in New Zealand (NZ) in 2001 were identified from a chemical injury database. Prescription and aggregate defined daily dose (DDD) data for NZ in 2001 were obtained from a national prescribing database. Rates of death per prescription and DDD, and relative rates between individual hypnosedatives and benzodiazepines, and their respective 95% CI were calculated Results. Of the 200 poisoning deaths in NZ for 2001, 39 involved hypnosedatives, and zopiclone was involved in 12. Hypnosedatives were the sole agents in only one death and were the primary agents in eight deaths. Zopiclone was the sixth most commonly involved agent in poisoning deaths in NZ in 2001. The relative rate of death per prescription (95% CI) and DDD (95% CI) of zopiclone compared with benzodiazepines were 1.04 (0.49–2.05) and 0.59 (0.28–1.16), respectively. The relative rates of death per DDD (95% CI) for alprazolam and chlormethiazole compared with the other sedatives/anxiolytics were 6.2 (1.6–17.0) and 20.9 (2.5–79.8) respectively. Conclusions. The fatal toxicity for zopiclone was not significantly different from that for benzodiazepines as a group when adjusted for usage, whereas alprazolam and chlormethiazole had greater toxicity. Hypnosedatives are contributory factors rather than primary substances in poisoning deaths.

Summary statement: New guidelines for the management of paracetamol poisoning in Australia and New Zealand

Alarge proportion of accidental paediatric exposures and deliberate self-poisoning incidents involve paracetamol; it is the leading pharmaceutical agent responsible for calls to Poisons Information Centres in Australia and New Zealand. Management of paracetamol poisoning has altered since the previous guidelines were published in 2008, so that they do not reflect current practice by clinical toxicologists. The key changes from the previous guidelines concern the indications for administration of activated charcoal; the management of patients taking large or massive overdoses; modified-release and supratherapeutic ingestions; and paediatric liquid paracetamol ingestion.

Illicit intravenous use of methylphenidate (ritalin) tablets: A review of four cases

Abstract Intravenous injection of crushed Ritalin (methylphenidate 10 mg) tablets has emerged as a current medical concern in New Zealand. We report the clinical features of four cases of methylphenidate toxicity arising from intravenous (IV) injection of crushed Ritalin tablets, and highlight concerns regarding this form of drug abuse. Two patients required intensive care management and one died approximately 10 hours after injection due to a ruptured cerebral aneurysm. Two other cases required management for a variety of clinical events including hyperpyrexia, coagulopathy and seizures. In the non-fatal cases, hyperpyrexia and tachycardia were the most consistent toxic effects noted. Hypertension was noted in only one of these cases but cannot be ruled out as the cause of the ruptured aneurysm in the one fatality. Emergency care providers are reminded of the abuse potential with this drug and the potential serious consequences of intravenous use.

Compliance with Poisons Center Referral Advice and Implications for Toxicovigilance

Background: When Poisons Information, or Poisons Control Centers (PCC) give directive advice in response to general public calls it is usually assumed that the advice will be followed, but it is difficult to measure the actual compliance of callers to a PCC. Epidemiological data regarding the incidence of poisoning incidents (Toxicovigilance) often utilizes reports of calls to a PCC. Methods: Retrospective review of advice given to all callers to the New Zealand National Poisons Centre (NZNPC) from a defined area for the calendar year 2001. Callers to the NZNPC telephone hotlines who were advised to attend or not to attend the hospital Emergency Department (ED) were subsequently matched with actual ED visits. Results: The compliance rate for those advised to attend the ED was 76.1%, whereas those advised not to attend had a compliance rate of 98.7%. The overall compliance rate was 94.1%. Of the patients presenting to the ED with a potential poisoning, only 10.2% were referred by the PCC. The callers referred by PCC and direct ED visitors appeared to differ in some respects. Conclusions: Compliance with PCC telephone advice is similar to the compliance rates in many other health interventions. Comparisons between populations calling a PCC and those self‐presenting to an ED show that PCC data may not reflect the true burden of poisoning to health care systems.

Clinical utility of an electronic poisons information and clinical decision support tool

The objective of the study was to assess the use of a computer toxicology database/clinical decision aid by clinical practitioners. The study investigated the sources that Emergency Department (ED) personnel use to obtain toxicology information and performed a quality audit of the current database. A questionnaire survey of ED staff was used in departments with access to the New Zealand Poisons Centre Substance Database (NZSD), a toxicology CD ROM computer database. Outcome measures were reported use of alternative data sources when managing clinical toxicology presentations and the qualities of the NZSD. Computer databases are commonly used for the management of clinical toxicology cases and the toxicology computer database/clinical decision aid studied is well accepted and used in Emergency Medicine practice. The users of the NZSD assessed the usability and quality of the information of the database.

TOXINZ, the New Zealand Internet poisons information database: The first decade.

The New Zealand National Poisons Centre has, over a number of years, developed an electronic poisons information database. In 2002, this was released as toxinz™ (University of Otago, Dunedin, New Zealand), an Internet accessible version. The objective of this study is to describe New Zealand subscriber utilisation of TOXINZ with an emphasis on pharmaceutical monographs viewed.

Use of poisons information resources and satisfaction with electronic products by Victorian emergency department staff.

ED staff use a range of poisons information resources of varying type and quality. The present study aims to identify those resources utilised in the state of Victoria, Australia, and assess opinion of the most used electronic products.