Tin Yat Anthony Chow

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: 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.

Introduction: This study aimed to investigate the availability of pet spider species in Hong Kong and spider keeper's perception of the danger of exotic spiders. Method: This is a cross‐sectional questionnaire study targeting Hong Kong spider hobbyists that was conducted from June to December 2024. Electronic questionnaires were distributed to spider hobbyists using the snowball sampling method. Physical and online stores were sampled for the availability of spider species. Local cases of consults related to exotic spiders were examined. Results: 75 participants responded to the survey, and 74 of them had kept Theraphosidae (tarantulas). The top three popular breeds were Grammostola , Brachypelma , and Caribena . Around 20% of them had been bitten by spiders, and 40% of them had been disturbed by urticating hair. Around half of them perceived the bite and urticating hair as dangerous. For the online and physical store visits, five families of spiders and 29 genera of tarantulas were available for sale. Discussion: The majority of the participants kept tarantulas. Despite some participants having experienced health risks, half of the participants did not view the risks as significant, indicating a potential knowledge gap. The study had limitations, such as a small sample size and reliance on self‐reported data, but offered insights into the local spider‐keeping community. Conclusion: Despite keeping exotic spiders, mostly tarantulas, who could be potentially dangerous to health, only around half of the exotic spider keepers were equipped with the proper knowledge to perceive the potential dangers. Further education among this population might be required.

Background: Extracorporeal membrane oxygenation (ECMO) is used in Hong Kong to provide additional circulation and respiratory support to patients. Exposure to toxins could cause profound shock and respiratory failure. The role of using ECMO to support severe circulatory and respiratory failure in patients with a toxicological cause of admission in Hong Kong is explored in this study.Objective: This study aims to describe the local practice of the use of ECMO in poisoning in Hong Kong.Method: This was a retrospective analysis of patients receiving ECMO for toxicological‐related causes between January 2013 and December 2023. Indications, the poisons of concern, and the mortality of the patients were reviewed.Results: We reported a total of 20 cases during the study period. Fourteen of them received VA‐ECMO, and six of them received VV‐ECMO. The most common poisons in patients receiving VA‐ECMO were calcium channel blockers and beta blockers. The ICU mortality rate for patients receiving VV‐ECMO was 16.6%, whereas it was 42.8% for those receiving VA‐ECMO. Of the 4 patients who received ECPR, the mortality rate was 75%. Most of the patients who survived had excellent cerebral performance category at 3 months.Conclusion: ECMO might be a useful modality for providing temporary respiratory and circulatory support to poisoned patients.

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.

Background: The Hong Kong Poison Information Centre has provided consultation service to healthcare professionals and collected epidemiological data on poisoning in Hong Kong since 2005.Objective: To analyse and report the poisoning data of Hong Kong Poison Information Centre in 2020 during the COVID‐19 pandemic.Methods: A retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2020.Results: A total of 3633 poisoning cases were analysed. Compared to 2019 (pre‐COVID era), there was a reduction of ~10% of total poisoning cases recorded (383 cases), with a majority (> 90%) of reduction from poisoning cases with no clinical effect (353 cases). A greater proportion of reduction was observed among the children (0–12 years), patients with general unintentional poisoning, poisoning due to therapeutic error and food poisoning. An increased number of cases was noted from abusive use, adverse herb/proprietary Chinese medicine reaction and poisoning related to household bleaches. Teenage (13–19 years) poisoning seemed to be unaffected by the COVID‐19 pandemic and the previously observed increasing trend continued (up to 11.8% of total poisoning cases this year). Despite a total reduction in poisoning cases recorded, the number of deaths increased by 37% from 35 in 2019 to 48 in 2020 (mortality rate 1.5%). A total of seven interesting cases were discussed.Conclusion: This 15th annual report provides updated epidemiological information on poisoning patterns in Hong Kong during the COVID‐19 pandemic. It also highlighted important changes and possible effects of the COVID‐19 pandemic on poisoning in Hong Kong in comparison with our previous reports.

Background: The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005.Objective: To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019.Methods: This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019.Results: A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex‐unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self‐harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co‐ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report.Conclusion: This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.

Objective: The aim of this study was to report and analyse the poisoning data of Hong Kong Poison Information Centre in 2018.Methods: In 2018, all poisoning cases received by Hong Kong Poison Information Centre were retrieved from its database, Poison Information and Clinical Management System, for analysis.Results: A total of 3960 poisoned cases were analysed. There were 1770 male patients (44.7%), 2188 female patients (55.3%) and 2 sex‐unspecified patients (<0.1%). The majority of cases (68.3%) were between 20 and 69 years old, and 9.9% involved children of 0–5 years old. The common causes of poisoning were suspected self‐harm/suicidal attempt (36.6%), unintentional exposure (18.4%) and abusive substance use (11.1%). Excluding the common co‐ingestant ethanol, the five commonest types of poison were benzodiazepines, paracetamol, Chinese herbal medicine, household products and zopiclone. Most patients were managed with supportive measures, while 13.5% and 13.7% of consultation cases were treated by decontamination and antidotes, respectively. The majority of cases had uneventful recovery; 0.8% resulted in death and 4.9% had major outcomes. A total of eight interesting cases were discussed.Conclusion: This 13th annual report provided the updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparison with our previous reports.

Gelsemium elegans is an extremely toxic plant, but gelsemium poisoning is seldom reported in the English literature. To evaluate the clinical manifestations and causes of gelsemium poisoning in Hong Kong. A retrospective review of gelsemium poisoning recorded by the Hong Kong Poison Information Centre from 2005 to 2017. In total, 33 cases (55% female, median age 44 (interquartile range: 30–56)) were identified in 14 incidences. Consumption of contaminated Ficus hirta (五指毛桃) soup is the commonest cause (52%). Other causes include misidentification of herbs (12%), consumption of parasitic plant Cassytha filiformis (無根藤) (15%) and suicidal ingestion of Gelsemium elegans (斷腸草) (3%). Most patients (94%) had mild to moderate toxicity, with one fatal case and one severe case presented with coma and respiratory depression. All patients complained of dizziness (100%), followed by visual blurring (34%) and nausea (28%). More than half (53%) had ocular manifestations (e.g. visual blurring, ptosis, nystagmus, diplopia) which are not commonly reported in other herbal poisoning. The time of symptom onset was early (median: 50 min (interquartile range: 30–60)) and all occurred within 2 h after oral intake. Most patients (94%) recovered uneventfully with conservative treatment. Most gelsemium poisoning in Hong Kong was due to contamination or misidentification. Early-onset dizziness (<2 h) with ocular symptoms after herbs consumption highly suggests Gelsemium poisoning. Good supportive care, particularly respiratory support, is the mainstay of management. Early recognition and the corresponding preventive measures would be useful.