Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.

Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995-2013. A retrospective analysis was performed to determine circu...

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Autores principales:	Claudia Gregoriano, Alessandro Ceschi, Christine Rauber-Lüthy, Hugo Kupferschmidt, Nicholas R Banner, Stephan Krähenbühl, Anne B Taegtmeyer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f2bacf81de264d5cb6edb3343f9516de
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spelling	oai:doaj.org-article:f2bacf81de264d5cb6edb3343f9516de2021-11-18T08:35:11ZAcute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.1932-620310.1371/journal.pone.0086390https://doaj.org/article/f2bacf81de264d5cb6edb3343f9516de2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24489721/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995-2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric) were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5). Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8) times the usual dose in adults. Twelve cases (30%) had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage) and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion.Claudia GregorianoAlessandro CeschiChristine Rauber-LüthyHugo KupferschmidtNicholas R BannerStephan KrähenbühlAnne B TaegtmeyerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 1, p e86390 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Claudia Gregoriano Alessandro Ceschi Christine Rauber-Lüthy Hugo Kupferschmidt Nicholas R Banner Stephan Krähenbühl Anne B Taegtmeyer Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.
description	Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995-2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric) were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5). Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8) times the usual dose in adults. Twelve cases (30%) had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage) and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion.
format	article
author	Claudia Gregoriano Alessandro Ceschi Christine Rauber-Lüthy Hugo Kupferschmidt Nicholas R Banner Stephan Krähenbühl Anne B Taegtmeyer
author_facet	Claudia Gregoriano Alessandro Ceschi Christine Rauber-Lüthy Hugo Kupferschmidt Nicholas R Banner Stephan Krähenbühl Anne B Taegtmeyer
author_sort	Claudia Gregoriano
title	Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.
title_short	Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.
title_full	Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.
title_fullStr	Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.
title_full_unstemmed	Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.
title_sort	acute thiopurine overdose: analysis of reports to a national poison centre 1995-2013.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/f2bacf81de264d5cb6edb3343f9516de
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Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.

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