Background: Suicide is a complex and tragic event deriving from mental disorders that include ideation, planning, and then attempting suicide. Among attempted suicides, self-poisoning is the most frequent method. Many of the toxic substances used with suicidal intent are frequently associated to the development of acute kidney injury (AKI), a life-threatening condition with high mortality. The aim of our study was to search across the literature to evaluate the final outcome (i.e., fatal or nonfatal) of patients referred to the ED due to AKI following suicidal attempt. Methods: A systematic search of case reports of AKI secondary to voluntary intake of toxic agents for suicidal intent was performed. For each case, age, sex, type of substance, therapy implemented in the ED, and clinical outcome (fatal and nonfatal), were recorded. Substances were divided into four main subgroups: toxic agents, cardiovascular drugs, analgesics, drugs acting on the central nervous system. Results: One hundred and eight cases of attempted suicide were identified (35±15 years, 57% males). Toxic agents were the most widely used substances (69.4%). The preferred route of administration was oral (94.5%). An outcome report was available in 75% of cases. Multivariate logistic regression analysis showed that dialysis was negatively associated with death (OR=0.254 [95%C.I. 0.074-0.434], p=0.006). Conclusions: Hemodialysis is widely used in order to improve survival since many toxic substances are effectively removed by filters. Emergency physicians should have some nephrologic expertise, to promptly investigate or even only early suspect a potential risk for AKI, and start adequate treatment.
Acute renal failure secondary to suicidal behavior: a systematic minireview of case reports referred to the ED.
FABBIAN, Fabio;STORARI A.;GRASSI, Luigi;MANFREDINI, Roberto
2013
Abstract
Background: Suicide is a complex and tragic event deriving from mental disorders that include ideation, planning, and then attempting suicide. Among attempted suicides, self-poisoning is the most frequent method. Many of the toxic substances used with suicidal intent are frequently associated to the development of acute kidney injury (AKI), a life-threatening condition with high mortality. The aim of our study was to search across the literature to evaluate the final outcome (i.e., fatal or nonfatal) of patients referred to the ED due to AKI following suicidal attempt. Methods: A systematic search of case reports of AKI secondary to voluntary intake of toxic agents for suicidal intent was performed. For each case, age, sex, type of substance, therapy implemented in the ED, and clinical outcome (fatal and nonfatal), were recorded. Substances were divided into four main subgroups: toxic agents, cardiovascular drugs, analgesics, drugs acting on the central nervous system. Results: One hundred and eight cases of attempted suicide were identified (35±15 years, 57% males). Toxic agents were the most widely used substances (69.4%). The preferred route of administration was oral (94.5%). An outcome report was available in 75% of cases. Multivariate logistic regression analysis showed that dialysis was negatively associated with death (OR=0.254 [95%C.I. 0.074-0.434], p=0.006). Conclusions: Hemodialysis is widely used in order to improve survival since many toxic substances are effectively removed by filters. Emergency physicians should have some nephrologic expertise, to promptly investigate or even only early suspect a potential risk for AKI, and start adequate treatment.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
