Man Li Tse

Background: The Hong Kong Poison Information Centre (HKPIC) has been providing consultation services to healthcare professionals and collecting epidemiological data on poisoning in Hong Kong since 2005. Objective: To analyse and report the poisoning data from HKPIC in 2022. Methods: A retrospective review was conducted on all poisoning cases recorded in the Poison Information and Clinical Management System of HKPIC in 2022. Results: A total of 3226 poisoning cases were analysed. There was a decrease of approximately 20% in total poisoning cases compared to 2021. Despite the decrease in the total poisoning caseload, there was an increase in the absolute number of poisoning‐related deaths by 14% (from 36 to 41) and cases with major outcomes by 31% (from 146 to 191), resulting in an increase in the case‐fatality rate from 1.0% in 2021 to 1.4% in 2022. More decontamination was performed and more antidotes were used in 2022 in comparison with the previous 5‐year average. Teenage (13–19 years) poisoning incidence continued to be high (16.3% of total poisoning cases). Additionally, four interesting cases and a few poisoning clusters were discussed. Conclusions: This 17th annual report provides valuable information on poisoning patterns in Hong Kong, highlighting the changes in local poisoning epidemiology during the third year of the COVID‐19 pandemic.

Background: Snakebite envenomation is a priority neglected tropical disease according to the World Health Organization. To address the issue, enhanced epidemiological evidence in endemic countries and an improved availability of snake antivenoms were proposed. Objectives: To understand the local epidemiology of snakebite cases, promote awareness of potential snakebite injuries in our locality, and provide insight on the presentation and management of these injuries. Methods: An epidemiological study reviewing cases between 2012 and 2021 in our Hong Kong Poison Information Center (HKPIC) database was conducted. Snakebite cases from 1 January 2012, to 31 December 2021, were identified from the HKPIC database, by using “snake” as the poison name or category. Results: A total of 592 cases were captured, approximately 59 cases per year. The top recognised offending snake was Green Pit Viper ( Trimeresurus albolabris ) (71.8%) followed by Chinese Cobra ( Naja atra ) (3.2%), and Many‐Banded Krait ( Bungarus multicinctus ) (2.2%). Native non‐venomous or minimally venomous snakes accounted for 4.1% and pet snakes for 2.5%. Snakebites most often occur during summer and autumn, between 7 and 9PM, in rural neighborhoods. Work‐related bites accounted for 19.3% of cases. Local cytotoxicity was seen in 88%, haemotoxicity in 45.3%, and neurotoxicity in 1.5% cases. Antivenom was administered in 58.1% cases, the acute allergic reaction rate was 3.5%. Conclusions: Life‐threatening severe cytotoxicity, haemotoxicity, and neurotoxicity were observed following native snakebites in Hong Kong. GPV was the commonest observed snakebite in our locality, accounting for 71.8% cases. The general principles of prompt medical care, snake envenomation recognition, and consideration of early antivenom treatment are all critical steps in reducing snakebite mortality and morbidity.

Background: Digoxin is a commonly used cardiovascular drug but has a narrow therapeutic window, and its poisoning could be fatal. Prognostic factors of digoxin poisoning were proposed largely based on the toxicokinetics of digoxin. Higher levels of evidence on this topic were limited. Objective: The study aimed to identify patient characteristics and risk factors associated with poor outcomes in acute or acute‐on‐chronic digoxin poisoning and to review the poor outcome rates, the time intervals between acute or acute‐on‐chronic digoxin poisoning and healthcare facility attendances, the overall mortality rate, and antidote usage of digoxin poisoning in Hong Kong. Methods: A retrospective cohort study was conducted using data from the Hong Kong Poison Information Centre from 1 January 2008 to 31 December 2022. Included were adult patients with acute or acute‐on‐chronic digoxin poisoning who presented to outpatient facilities. Excluded were individuals under 18 years, pregnant, had incomplete or unrelated medical records. Univariate and multivariable logistic regression analyses were used to identify predictors of poor outcomes. Results: During the study period, 57 adult cases of digoxin poisoning were identified for further analysis. Among these patients, 36 (63%) had good outcomes (no effect, minor effect, or moderate effect from the poisoning) while 21 (37%) had poor outcomes (major effect or death), and there were 8 (14%) deaths in total. Multivariable analysis and analysis of the receiver operating characteristic curve revealed that poor outcomes were significantly associated with an initial systolic blood pressure below 123.5 mmHg ( p = 0.034), an initial pulse rate below 59.5 beats per minute ( p = 0.009), and a serum potassium level above 4.64 mmol/L ( p = 0.018). Conclusions: In adult patients with acute or acute‐on‐chronic digoxin poisoning, the initial systolic blood pressure, pulse rate, and potassium levels are the most important predictors of poor outcomes upon initial presentation. These findings allow early recognition of patients with poor outcomes for further management.

Background: Territory‐wide epidemiological studies of acute Chinese medicine poisoning involving aconite after 2010 are lacking. Objectives: To characterise the latest trends, presumed causes, clinical presentations, healthcare utilisation and patient outcomes of such poisoning cases in Hong Kong. Methods: This was a retrospective observational study of consecutive patients reported to the Hong Kong Poison Information Centre for acute Chinese medicine poisoning by all public emergency departments (EDs) between 1 July 2008 and 30 June 2021. Aconite poisoning was defined by clinical toxicologist verification and laboratory detection of aconitine, related alkaloids or their metabolites in patient biological or herbal remnant samples. We analysed trends using a negative binomial model and characterised presentations using descriptive statistics. Results: In total, 179 episodes of laboratory‐confirmed aconite poisoning occurred during the study period. The median annual incidence was 0.22 per 100,000 population (interquartile range 0.11–0.27), with a significant downward trend from 2009 to 2020 (relative risk 0.93, p = 0.037). Fuzi was the most frequently implicated herb (59.2%) and decoction was the most common herbal formulation. Most cases were related to the consumption of Schedule 2 processed aconite. Self‐purchase was common. Overdose accounted for 55.5% of cases with available dose information. Supportive treatment remained the mainstay of management. The mortality rate was 1.1%. Conclusions: Despite a decline in incidence, Chinese medicine poisoning with aconite remains a recurring and life‐threatening problem in local EDs. Limiting the dose per sale in self‐purchase and strengthening public education on appropriate aconite use may further reduce such toxicities.

Aconitum spp. alkaloids, used in traditional Chinese medicine, are potent cardiotoxins and neurotoxins. Timely diagnosis of aconite poisoning remains challenging due to the long laboratory turnaround time. We aimed to derive and internally validate a diagnostic score for rapid recognition of acute Chinese medicine poisoning involving aconite using clinical parameters. We conducted a retrospective cross-sectional study on consecutive patients with laboratory-confirmed Chinese medicine poisoning reported to the Hong Kong Poison Control Centre between 1 July 2008 and 30 June 2021. The reference standard was the diagnosis of acute aconite poisoning by a clinical toxicologist and laboratory detection of aconitine or related alkaloids in the patients' urine, serum, or gastric lavage specimens. Univariate analyses, followed by multivariable logistic regression, were performed to identify independent predictors of laboratory-confirmed aconite poisoning. A scoring system was developed based on the regression coefficients of the independent predictors and internally validated using bootstrapping. We identified 542 eligible episodes, of which 179 involved aconite and 363 involved other herbs. The median patient age of the included episodes was 55 years (range 4-98 years). A clinical diagnostic score was developed based on the six independent predictors: hypotension (systolic blood pressure <90 mmHg in adults or < age-appropriate ranges in children, 3 points), herbal decoction or wine formulation (2 points), facial or oral numbness (2 points), ventricular tachycardia (1 point), limb numbness (1 point), and premature atrial or ventricular contractions (1 point). The score ranges from 0 to 10, with a higher score indicating a higher likelihood of aconite poisoning. At the cutoff point of ≥3, the sensitivity and negative predictive value of the score were 0.98 and 0.99, respectively. A higher specificity (0.92) and positive predictive value (0.84) could be achieved with a cutoff point at ≥4. The area under the receiver operating characteristic curve was 0.965 (95% CI: 0.950-0.980) during derivation and 0.965 (95% bias-corrected and accelerated CI: 0.947-0.977) during internal validation. The newly derived Clinical Aconite Poisoning Score is simple to use, but its real-time discriminatory performance in diverse populations with Chinese medicine poisoning in real-world settings and its impacts on clinical management are unknown. In the context of Chinese medicine poisoning, the Clinical Aconite Poisoning Score might be useful in early recognition of aconite poisoning before laboratory confirmation. Future prospective studies are warranted to externally validate its real-time discriminatory performance in real-world settings before clinical adoption.

IntroductionThe toxicokinetics of methyl salicylate after unintentional or intentional ingestion of medicinal oil containing methyl salicylate has not been well studied. We aimed to characterize the trajectory of serum salicylate concentrations and to evaluate factors associated with the peak serum salicylate concentration and the time from ingestion to peak concentration.MethodsThis was a retrospective cohort study of consecutive patients reported to the Hong Kong Poison Control Centre for laboratory-confirmed methyl salicylate poisoning by all local public emergency departments between 1 July 2008 and 30 June 2023. We analyzed cases with at least three serum salicylate concentrations. Multivariable generalized linear regression was used to identify factors significantly associated with the peak serum concentration and the time from ingestion to peak concentration.ResultsWe included 41 patients (median age 81.0 years; 32 women and nine men). The median time from ingestion to the first peak serum salicylate concentration was 5.6 h (IQR: 3.2-10.8 h). Multiple regression showed that gastric aspiration (adjusted regression coefficient [beta] - 2.50; 95% CI: -3.93 to -1.08; P = 0.001) and single-dose activated charcoal (adjusted beta - 1.22; 95% CI: -2.02 to -0.42; P = 0.003) were significantly associated with a lower peak concentration, after adjusting for patient age, sex, exposure due to intentional self-harm, reported ingested dose, time from ingestion to emergency department presentation, vomiting, concurrent use of aspirin (acetylsalicylic acid) and other medications that affect gastric emptying or gastric acid secretion, blood pH, serum albumin concentration, and creatinine clearance.DiscussionThe serum salicylate concentration did not peak as quickly as generally believed, highlighting the importance of continued monitoring. Gastric aspiration and single-dose activated charcoal may help reduce gastrointestinal absorption, but their impact on clinical outcomes remains unclear.ConclusionsGiven the median time of 5.6 h (IQR: 3.2-10.8 h) from ingestion to the peak salicylate concentration, gastric aspiration and single-dose activated charcoal can be considered in patients up to a few hours after medicinal oil ingestion when the airway is protected.

Introduction: The Hong Kong Poison Information Centre (HKPIC) has been providing consultation services to healthcare professionals and collecting epidemiological data on poisoning in Hong Kong since 2005.Objective: To analyse and report the poisoning data from HKPIC in 2021.Methods: A retrospective review was conducted on all poisoning cases recorded in the Poison Information and Clinical Management System of HKPIC in 2021.Results: A total of 3973 poisoning cases were analysed. There was an increase of approximately 10% in total poisoning cases compared to 2020, bringing the total caseload back to the pre‐COVID era. Teenage (13–19 years) poisoning incidence continued to rise, reaching a recorded high of 16.2% of total poisoning cases. Notably, poisoning cases involving selective serotonin receptor inhibitors showed a significant increase, along with the use of the antidote cyproheptadine. The majority of these cases involved individuals under the age of 20 presenting with suspected self‐harm. Compared to 2020, the number of poisoning‐related deaths decreased by 25%, from 48 to 36 deaths in 2021, resulting in a case fatality rate of 1.0%. Additionally, six interesting cases and two poisoning clusters were discussed.Conclusions: The 16th annual report provides valuable information on poisoning patterns in Hong Kong during the second year of the COVID‐19 pandemic, highlighting significant changes compared to previous reports.