Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
권호 표지
DOI QR코드

DOI QR Code

Zolpidem Detection and Blood Level in Acute Poisoning-suspected Patients in Emergency Departments: Review of 229 Cases

급성중독 응급실 환자에서 Zolpidem 검출과 농도: 일개 중독분석실 229명 사례

  • Yu, Jaehyung (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chang, Hanseok (National Emergency Medical Center, National Medical Center) ;
  • Won, Sinae (National Emergency Medical Center, National Medical Center) ;
  • Yeom, Jeonghun (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Arum (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Na-Youn (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Bum Jin (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 유재형 (서울아산병원 응급의학과) ;
  • 장한석 (국립중앙의료원 중앙응급의료센터) ;
  • 원신애 (국립중앙의료원 중앙응급의료센터) ;
  • 염정훈 (서울아산병원 응급의학과) ;
  • 이아름 (서울아산병원 응급의학과) ;
  • 박나연 (서울아산병원 응급의학과) ;
  • 오범진 (서울아산병원 응급의학과)
  • Received : 2019.07.18
  • Accepted : 2019.09.15
  • Published : 2019.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Non-benzodiazepine hypnotic drugs (including zolpidem) are associated with an increased risk of suicide and suicidal ideation. Considering the wide usage of zolpidem, this drug should be considered a possible etiology for stupor or coma in any patient exposed to this drug. However, there are no reports on zolpidem blood levels in emergency department patients in Korea. We therefore reviewed the analyzed data of a toxicology laboratory at one university affiliated hospital. Methods: The sex, age, chief symptoms, suspiciousness of poisoning, and presumption of poison were analyzed from January 2018 to June 2019. The detection frequency and level of zolpidem in the patient blood were compared to the mental changes presented, which is the main consequence of zolpidem. Results: A total of 229 toxicological analyses, requested to a toxicological laboratory at one university affiliated hospital, were reviewed. Among 229 patients, the mean age was 54.3±20.7 years old with 113 women and 116 men. 8.7% of patients have psychiatric illness and 39.7% were poisoned intentionally. The chief symptoms detected were: mental change 55.0%, gastrointestinal 14.4%, cardiovascular 10.5%, focal neurological 7.4%, respiratory 3.5%, none 8.7%, and unknown 0.4%. A request for detailed reports revealed that causative poisons were specified only in 20.1% cases. Zolpidem was detected in 22.3% cases (51/229), with median blood level 1.26 mg/L (interquartile 0.1, 5.06 mg/L) and urine 0.90 mg/L (interquartile 0.11, 5.6 mg/L). Furthermore, zolpidem was more frequently detected in toxicology analysis of patients where mental change was the primary symptom, as compared to other symptoms (32.5% vs. 9.7%, p<0.01). Conclusion: This study reported the blood level of zolpidem in suspected poisoning patients admitted to the emergency department.

Keywords

References

  1. Hajak G, Muller WE, Wittchen HU, et al. Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction 2003;98(10):1371-8. https://doi.org/10.1046/j.1360-0443.2003.00491.x
  2. Wong CK, Marshall NS, Grunstein RR, et al. Spontaneous Adverse Event Reports Associated with Zolpidem in the United States 2003-2012. J Clin Sleep Med 2017;13(2):223-34. https://doi.org/10.5664/jcsm.6452
  3. Jang Y, Song I, Oh IS, et al Twelve-year trend in the use of zolpidem and physicians' non-compliance with recommended duration: a Korean national health insurance database study. Eur J Clin Pharmacol 2019;75(1):109-17. https://doi.org/10.1007/s00228-018-2563-9
  4. Garnier R, Guerault E, Muzard D, et al. Acute zolpidem poisoning--analysis of 344 cases. J Toxicol Clin Toxicol 1994;32(4):391-404. https://doi.org/10.3109/15563659409011040
  5. Kuzniar TJ, Balagani R, Radigan KA, et al. Coma with absent brainstem reflexes resulting from zolpidem overdose. Am J Ther 2010;17(5):e172-4. https://doi.org/10.1097/MJT.0b013e318188bdca
  6. Gock SB, Wong SHY, Nuwayhid N, et al. Acute zolpidem overdose - Report of two cases. J Anal Toxicol 1999;23(6):559-62. https://doi.org/10.1093/jat/23.6.559
  7. Statistics Korea. Press release of 2015 statistics for death reason. http://kostat.go.kr/portal/eng/pressReleases/8/10/index.board?bmode=download&bSeq=&aSeq=357968&ord=1/. Accessed January 13, 2019.
  8. Sohn CH, Ryoo SM, Lim KS, et al. Kind and Estimated Stocking Amount of Antidotes for Initial Treatment for Acute Poisoning at Emergency Medical Centers in Korea. J Korean Med Sci 2014;29(11):1562-71. https://doi.org/10.3346/jkms.2014.29.11.1562
  9. Salva P, Costa J. Clinical pharmacokinetics and pharmacodynamics of zolpidem. Therapeutic implications. Clin Pharmacokinet 1995;29(3):142-53. https://doi.org/10.2165/00003088-199529030-00002
  10. Gunja N. The clinical and forensic toxicology of Z-drugs. J Med Toxicol 2013;9(2):155-62. https://doi.org/10.1007/s13181-013-0292-0
  11. Drover D, Lemmens H, Naidu S, et al. Pharmacokinetics, pharmacodynamics, and relative pharmacokinetic/pharmacodynamic profiles of zaleplon and zolpidem. Clin Ther 2000;22(12):1443-61. https://doi.org/10.1016/S0149-2918(00)83043-X
  12. Sun Y, Lin CC, Lu CJ, et al. Association Between Zolpidem and Suicide: A Nationwide Population-Based Case-Control Study. Mayo Clin Proc 2016;91(3):308-15. https://doi.org/10.1016/j.mayocp.2015.10.022
  13. Park KH, Park JS, Lee SW, et al. Changes of Poison Data Characteristics Collected from Telephone Response in 1339 and 119: Discrepancy in Characteristics of Post-toxin Exposure Data Obtained through Telephone Counselling Provided by 1339 and 119. J Korean Soc Clin Toxicol 2017;15(2):116-21. https://doi.org/10.22537/jksct.15.2.116
  14. Gummin DD, Mowry JB, Spyker DA, et al. 2016 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila) 2017;55(10):1072-252. https://doi.org/10.1080/15563650.2017.1388087
  15. Han CS, Jeon WC, Min YG, et al. Retrospective Analysis on the Clinical Differences of Children and Adolescents Treated for Acute Pediatric Poisoning in an Emergency Department? J Korean Soc Emerg Med 2013;24(6):742-9.
  16. Lee K, Kim KH, Shin DW, et al. Trends in Korean Pediatric Poisoning Patients: Retrospective Analysis of National Emergency Department Information System. J Korean Soc Clin Toxicol 2017;15(2):69-78. https://doi.org/10.22537/jksct.15.2.69
  17. Hamad A, Sharma N. Acute zolpidem overdose leading to coma and respiratory failure. Intensive Care Med 2001;27(7):1239. https://doi.org/10.1007/s001340100972
  18. Chung SP, Lee MJ, Kang H, et al. Analysis of Poisoning Patients Using 2016 ED Based Injury in-depth Surveillance Data. J Korean Soc Clin Toxicol 2017;15(2):86-93. https://doi.org/10.22537/jksct.15.2.86
  19. Kim SJ, Choa MH, Park JS, et al. Different Characteristics of Toxic Substance/poison Exposure Data that Collected from Pre-hospital Telephone Response and Emergency Department. J Korean Soc Clin Toxicol 2014;12(1):1-7.
  20. So BH, Lee MJ, Kim H, et al. 2008 Database of Korean Toxic Exposures: A Preliminary Study. J Korean Soc Clin Toxicol 2010;8:51-60.
  21. Darke S, Deady M, Duflou J. Toxicology and characteristics of deaths involving zolpidem in New South Wales, Australia 2001-2010. J Forensic Sci 2012;57(5):1259-62. https://doi.org/10.1111/j.1556-4029.2012.02117.x
  22. Reidy L, Nolan B, Ramos AR, et al. Zolpidem urine excretion profiles and cross-reactivity with ELISA((R)) kits in subjects using Zolpidem or Ambien((R)) CR as a prescription sleep aid. J Anal Toxicol 2011;35(5):294-301. https://doi.org/10.1093/anatox/35.5.294
  23. Huynh K, Wang G, Moore C, et al. Development of a homogeneous immunoassay for the detection of zolpidem in urine. J Anal Toxicol 2009;33(8):486-90. https://doi.org/10.1093/jat/33.8.486