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Published on: April 8, 2021
Poisoning-related bowel infarction: characteristics and outcomes
Jean-Charles Nault1, Bruno Mégarbane, Jonathan Théodore
1Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Réanimation Médicale et Toxicologique, Université Paris - Diderot, Paris, France.
Background:
Bowel infarction (BI) is a rare complication of poisoning. We aimed to describe the characteristics of BI in poisoned patients compared to nonpoisoned patients.
Methods:
A retrospective review over a 4-year period of patients hospitalized in an intensive care unit who were diagnosed with BI; Mann-Whitney and Fischer's exact tests were used for comparisons.
Results:
Seventeen patients with BI [11 F/6 M, 66-year olds (55-72), median (25-75% percentiles)], including five out of around 1,800 poisoned patients, were identified (toxicants: nicardipine + venlafaxine, amlodipine, propranolol + hydroxyzine, dextropropoxyphene + clomipramine, and turpentine). Clinical presentation and severity were comparable between both groups. However, poisoned patients were significantly younger (p = 0.03) with less cardiovascular disease (p = 0.04) and fewer risk factors (p = 0.008). Delayed BI occurred 48 h (36-60) after the start of vasopressor administration [15.5 mg/h (4.5-30.0) norepinephrine and 6.0 mg/h (4.9-6.3) epinephrine]. Typical poisoning-related injury was jejunal ischemia without ileal localization. The predominant mechanism was nonocclusive mesenteric ischemia. Mortality was lower in poisoned patients (20 vs. 90%, p = 0.009).
Conclusion:
Physicians should be aware that, despite patient age and the lack of cardiovascular risk factors, BI may rarely complicate severe poisonings requiring elevated doses of vasopressors and may present in a delayed fashion.
Insights
Bowel infarction (BI) is a rare poisoning complication. Poisoned patients with BI were younger, had fewer risk factors, and lower mortality than non-poisoned patients, despite similar presentation.
Area of Science:
- Medical Sciences
- Toxicology
- Gastroenterology
Background:
- Bowel infarction (BI) is an uncommon but serious complication of poisoning.
- Understanding the specific characteristics of BI in poisoned individuals is crucial for clinical management.
Purpose of the Study:
- To compare the clinical features and outcomes of bowel infarction in poisoned patients versus non-poisoned patients.
- To identify unique aspects of BI in the context of toxicological emergencies.
Main Methods:
- Retrospective review of intensive care unit patients diagnosed with BI over a four-year period.
- Statistical analysis using Mann-Whitney and Fischer's exact tests for group comparisons.
- Identification of specific toxicants and vasopressor use in the poisoned BI cohort.
Main Results:
- Five poisoned patients (out of ~1800) experienced BI, with toxicants including nicardipine, venlafaxine, amlodipine, propranolol, hydroxyzine, dextropropoxyphene, clomipramine, and turpentine.
- Poisoned patients were younger (p=0.03), had less cardiovascular disease (p=0.04), and fewer risk factors (p=0.008) compared to non-poisoned BI patients.
- Delayed BI (median 48h) occurred with high-dose vasopressors; nonocclusive mesenteric ischemia was the primary mechanism, and mortality was significantly lower in poisoned patients (20% vs. 90%, p=0.009).
Conclusions:
- Bowel infarction can occur in poisoned patients, even without typical risk factors.
- Physicians must consider BI in severe poisonings, especially those requiring vasopressors, as it may present with delayed onset.
- The distinct profile of poisoned BI patients suggests unique pathophysiological mechanisms warranting further investigation.
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