This work has focused on elaborating a clinical and sociodemographic profile of the AP treated in the emergency service in Bajo Aragón. Spain. The results cover a period of 3 years and include patients of all ages. It adds interest to this research that it is the first analysis of intoxications in this region.

The consultation rate is practically identical to that reported by other Emergency Departments (9, 10). This concordance of results strengthens the methodology developed in this work. Since our hospital does not have a Clinical Toxicology Unit in the hospital, it was necessary to create its registry of intoxicated patients based on the diagnostic codes assigned to emergency discharge (7).

In the age analysis, a considerable number of patients over 65 years of age (21.3%) were detected. This has led to a rise in the average age, even more so if other publications are taken into account (5, 9, 10, 14). In this sense, it must be taken into account that the region is one of the Spanish provinces with the highest average age (15).

Regarding the distribution by days of the week, the incidence found in other EP and Primary Care was repeated (10, 16). During the weekends, there was a predominance of drug abuse. In addition, the Bajo Aragón concentrates on its local festivals and the celebration of the MotoGP motorcycle world championship in the month of September, so the consumption of psychoactive substances was widespread on those days. This would explain why September was the month with the highest number of cases.

In the analysis of drugs of abuse, alcohol poisoning occupied the most prominent place, something common even at early ages (6, 9, 10, 14, 17). Alcohol was implicated in 45.5% of the total IAs. Cannabis intoxications also stood out, which were ahead of other drugs such as cocaine and amphetamines. In this way, cannabis was confirmed as the illegal substance that caused the most emergencies in Alcañiz. Something that contrasts with the low perception of risk declared by its consumers (18–20). None of the drugs found was new psychoactive substances (synthetic cannabinoids, synthetic cathinone's, piperazines, etc.). At the moment, very few Spanish hospitals are capable of detecting them (12). Drug intoxications were widely distributed. However, benzodiazepine overdoses are very prominent in Spanish Eds (9, 10). In Alcañiz they have been present in 19% of the queries by Accurate Intoxications (AI). The most outstanding data was the incidence of antiarrhythmic drugs in these poisonings, even more so when compared to other hospitals (9–11, 14). The numerous emergencies caused by these drugs are striking, and that 92.3% of them were concentrated in those over 65 years of age. An aging population may have significantly influenced this result. AIs suffered by the elderly are targeted by many authors due to their epidemiological and preventive interest (21, 22).

Exposures to chemical products had a smaller scope than drugs of abuse and medications. The respiratory route was the preferred form of entry for these toxins. Carbon monoxide (CO), chlorine gas, and bleach completed 3 out of 4 poisonings in this group. Interestingly, no cases were recorded from agricultural products, something that might be expected in a rural setting. CO was the most frequent gas. In most cases, the source of CO was due to the incomplete combustion of stoves and heaters in the domestic environment (23). Our region registers very low temperatures during the winter, which may have favored this type of poisoning (24).

In the region, a total of 31 CO intoxications were treated, of which 7 (22%) presented respiratory symptoms. This data contrasts with the percentage of patients (84.6%) who underwent determination of COHb in arterial blood. It is essential that initiatives such as those proposed by the Spanish Foundation for Clinical Toxicology with the “Actions to avoid in acute patient care” gain visibility and help improve aspects such as this (25, 26). Within the therapeutic framework, support measures were the fundamental pillar in treating acutely intoxicated patients, above measures of decontamination, purification, administration of antidotes or any other procedure. The number of digestive decontaminations performed in this study was high compared to the records published annually by the American Association of Poison Control Centers (AAPCC) (27). Many studies have revealed that the combination of LG and CA is not more effective than the exclusive administration of CA (28, 29). However, in Alcañiz, this association occurred 1 out of 3 times. Both the AAPCC and the European Association of Poison Centers and Clinical Toxicologists establish that the routine use of LG in the emergency room should disappear (29). However, the number of decontaminations that is currently performed in clinical practice is decreasing, due to the risk of the appearance of severe complications, such as bronchial aspiration (26, 29–32). Combined treatment with thiamin, pyridoxine and glucose was very widespread in alcohol poisoning. The first two drugs were administered in 42.3% of these abuses, and the three drugs were given in 29.8%. However, none of them is the antidote for acute alcohol intoxication.

National or international recommendations do not include thiamine in the basic provision of antidotes to be used in the care of the intoxicated. In addition, its systemic administration (intravenous or intramuscular) is not recommended. Its use is only appropriate in patients with a clear profile of chronic alcoholism or apparent signs of nutritional deficiencies when they present alcohol intoxication that requires intravenous glucose to correct hypoglycemia to avoid Wernicke's encephalopathy (3, 4, 33, 34). Since these circumstances are exceptional, it is more than likely that these patients have been overused, unnecessarily exposing them to adverse effects. On the other hand, the characteristics of the hospital itself had an influence on some of the results obtained. An example is the transfer rate to other hospitals (8.6%). Alcañiz does not have an ICU or a Psychiatric CSU, so the most severe patients were transferred to the reference hospitals (35). Assistance to an intoxicated person in a regional hospital can have certain advantages. The patients spent little time in the waiting room, and this favored a high-resolution rate in the first few hours. On the contrary, the space is smaller. Perhaps with an emergency observation area with more than 5 beds, the number of admitted patients would have been lower (12).

Some limitations should be considered in this study. This is a retrospective study that only included patients from a single-center. In addition, the most important limitations have been related to time variables. For example, in most cases the care interval was not recorded, nor was the toxic interval (intake-carbon). This has not allowed a more complete analysis of aspects as notable as the correct indication of digestive decontamination and other quality indicators. Further studies should be carried out.