Summary

Mortality from acute poisoning in Spanish hospitals (EXITOX Registry 2012–2019)

Blanca Rodríguez-Gamella¹, Santiago Nogué-Xarau^2,5, Ana Ferrer-Dufol^3,5, Guillermo Burillo-Putze^4,5, Jordi Puiguriguer-Ferrando⁶, en representación del grupo EXITOX

Affiliation of the authors

¹Tribunal Superior de Justicia de Madrid, Peritación Químico Forense, Madrid, Spain. ²Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Clínic, Barcelona, Spain. ³Unidad de Toxicología Clínica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. ⁴Servicio de Urgencias Hospital Universitario de Canarias, Tenerife, Spain. ⁵Fundación Española de Toxicología Clínica (FETOC). ⁶Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario son Espases, Palma de Mallorca, Spain.

DOI

Download Article

Quote

Rodríguez-Gamella B, Nogué-Xarau S, Ferrer-Dufol A, Burillo-Putze G, Puiguriguer-Ferrando J, en representación del grupo EXITOX. Mortality from acute poisoning in Spanish hospitals (EXITOX Registry 2012–2019). Rev Esp Urg Emerg. 2025;4:142–7

Summary

INTRODUCTION. Although in the emergency department setting, in-hospital mortality due to acute poisoning is a rare finding, its analysis gives valuable insights for future care.
MATERIAL AND METHODS. We conducted an observational study of patients who died from acute poisoning in the emergency departments of 13 Spanish public hospitals from 2012 through 2019 based on the EXITOX registry promoted by the Spanish Foundation of Clinical Toxicology (FETOC). The registry includes epidemiological, clinical, therapeutic variables and death-related data.
RESULTS. A total of 172 cases were recorded (58.7%, men). The mean age was 58.4 years (SD, 20.9). A total of 40.7% of the cases were due to suicide and 30.2% to drug overdoses. The main route of exposure was oral (75%), and in 127 cases (76.1%) poisoning involved a single substance. Chemical/household products (32.6%) and drugs (31.4%) were the most common toxic agents. The most common substances were hydrochloric acid (14%), cocaine (11%), and metformin (9.9%). Ethanol and benzodiazepines were involved in 63.2% of cases, almost always as part of polysubstance use. The most common initial clinical presentation was decreased
level of consciousness, followed by cardiac arrest. The leading mechanisms of death were multiple organ failure, anoxic encephalopathy, or internal injuries due to caustic ingestion. Antidotes were administered in 30.4% of cases, extracorporeal elimination in 9.8%, and GI decontamination in 6.4%.
CONCLUSION. This is the first Spanish study on in-hospital mortality from acute poisoning, which identified 2 primary profiles of deceased patients: caustic ingestions in the context of suicide and drug-related iatrogenic complications (metformin, digoxin) in elderly patients. Deaths were also observed in young individuals after polysubstance use involving alcohol, cocaine, and benzodiazepines. The study should support the implementation of preventive measures in avoidable cases.