Unveiling the spectrum of acute intoxication at a Norwegian university hospital: A Retrospective Study

Introduction Acute intoxication is a major reason for hospital admission and poses a significant burden on emergency departments (EDs) worldwide. The pattern of poisoning agents changes over time, making up-to-date information necessary for effective prevention and treatment. However, studies investigating the epidemiology and clinical characteristics of acute poisoning in Norway are scarce, particularly in regions outside the capital city of Oslo. This retrospective study aimed to describe the pattern of acute poisoning among patients admitted to the ED at a university hospital in Trondheim, Norway. Methods: This study included patients admitted to the ED at St. Olav's Hospital between 1 January 2019 and 31 December 2020 due to acute intoxication. Acute intoxication was defined as recent exposure to one or more substances in an assumed toxic amount. Data on poisoning agents and treatment were collected from electronic patient records, while demographic and logistic data were obtained from the ED database and Patient Administration System. Results: A total of 1423 patients were included, representing 2.7% of all ED visits during the study period. The median age was 34 years (interquartile range 24-50, range 14-101), and 53.6% (n=763) were males. A significant proportion of patients were readmitted for acute poisoning (n=168, 20.1%). Most patients arrived at the ED by ambulance (n=844, 59.3%), and 23.3% (n=331) had the highest acuity level at triage. The most frequent poisoning agents were ethanol (n=802, 56.4%), benzodiazepines (n=341, 24.0%), opioids (n=243, 17.1%), paracetamol (n=155, 10.9%), and antipsychotics (n=153, 10.8%). Almost half of the patients (n=666, 46.8%) were exposed to multiple substances. Males were more likely to have used several substances of abuse, while females were more likely to have used pharmaceuticals. After arrival at the ED, 20.1% (n=54) received antidote(s), 3.8% (n=54) received activated charcoal, and gastric lavage was performed in 3.0% (n=42) of cases. Among the ED visits, 76.3% (n=1086) resulted in hospital admission, and 17.9% (n=254) were assigned to a step-down unit or an intensive care unit. No deaths occurred during hospitalization. Conclusion: The findings of this study demonstrate a wide range of substances among patients with acute intoxication at St. Olav's Hospital in Trondheim, Norway. There was a high incidence of poisoning with multiple agents. Notably, poisoning with ethanol and opioids was more common than in previous studies of hospitalized patients in Norway. Nevertheless, the in-hospital prognosis was favorable, with no deaths occurring during hospitalization. This study's provided valuable and updated information on acute intoxication in a Norwegian urban setting.