Dag Jacobsen

• Vangstad, Marie; Birkeland, Jon Arne Kro; Gulsvik, Anne Kristine; Ervik, Ragnhild Louise; Oftebro, Ingrid & Brekke, Fredrik B. [Vis alle 9 forfattere av denne artikkelen] (2026). Exertional rhabdomyolysis: clinical features, management, complications and prediction of acute kidney injury. BMJ Open sport & exercise medicine. 12(1), s. 003214–003214. doi: 10.1136/bmjsem-2026-003214. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To describe the clinical course and complications of exertional rhabdomyolysis, compare inpatient and outpatient management, and evaluate admission markers of acute kidney injury (AKI). Methods: Prospective, multicentre study with consecutive inclusion of patients with rhabdomyolysis (creatine kinase (CK) ≥5000 U/L and/or myoglobin ≥1000 ng/mL) with exercise as the precipitating factor, presenting to the emergency departments of four hospitals in Oslo and Akershus, Norway (2019–2022). Management followed usual care. Primary outcome was AKI, defined by Kidney Disease: Improving Global Outcomes criteria. Results: We included 136 patients with exertional rhabdomyolysis (median age 28 years, 55% male), mainly after strength training (106, 78%); 62 (46%) were managed as inpatients and 74 (54%) as outpatients. Management was similar in both groups, consisting of fluids, serial blood tests, with a median follow-up of 3 days. Complications were rare and no outpatients required escalation to inpatient care. Five (4%) patients developed AKI (median peak creatinine 217 µmol/L, 132–410). Other major complications (severe electrolyte disturbances and compartment syndrome) occurred only in those with AKI. All patients who developed AKI had serum creatinine above the normal reference range at admission, though a few patients with elevated creatinine did not develop AKI (95% specificity). The myoglobin-to-CK ratio (≥0.48) performed best among muscle injury biomarkers and might serve as a supportive high-risk marker (99% specificity). Conclusion: No patient with a normal admission creatinine developed AKI in this cohort, supporting outpatient management as a safe option for otherwise healthy individuals when admission creatinine is within the reference range, provided follow-up is ensured. Trial registration number NCT04118608 .

• Vangstad, Marie; Gulsvik, Anne Kristine; Birkeland, Jon Arne Kro; Ervik, Ragnhild Louise; Brekke, Fredrik B. & Akkouh, Omar Ahmed [Vis alle 8 forfattere av denne artikkelen] (2026). Myoglobin-to-creatine kinase ratio enhances prediction of acute kidney injury in rhabdomyolysis. Emergency Medicine Journal. ISSN 1472-0205. s. 215470–215470. doi: 10.1136/emermed-2025-215470. Fulltekst i vitenarkiv Vis sammendrag

  Background Acute kidney injury (AKI) is a key complication of rhabdomyolysis. Creatine kinase (CK), the standard muscle injury biomarker, has limited predictive value. Myoglobin may be more accurate but has its limitations. The myoglobin-to-CK ratio may be a stronger predictor but lacks prospective validation. We aimed to validate this ratio using admission values, compare it with CK and myoglobin, and identify thresholds for early AKI risk stratification. Methods Prospective multicentre cohort study across four hospitals in Oslo and Akershus, Norway (2019–2022). All adults with CK ≥5000 U/L and/or myoglobin ≥1000 ng/mL at emergency department presentation or within 72 hours thereafter were eligible, irrespective of admission. Primary outcome was AKI. Predictive performance of CK, myoglobin and the myoglobin-to-CK ratio was assessed using logistic regression and receiver operating characteristic (ROC) analysis. Results In the 310 included patients, 108 (35%) developed AKI. In ROC analysis the myoglobin-to-CK ratio was the strongest predictor of AKI on admission (area under the curve (AUC) 0.84, 95% CI 0.79 to 0.89), followed by myoglobin (AUC 0.73, 95% CI 0.67 to 0.79); CK was a weak predictor (AUC 0.31, 95% CI 0.25 to 0.37). In quartile analysis, 72% of patients in the highest ratio quartile developed AKI, with a ratio ≥0.20 indicating risk. For myoglobin, 65% in the highest quartile developed AKI, with values ≥6372 ng/mL indicating risk. ROC analysis identified optimised cut-offs of 0.48 for the ratio (sensitivity/specificity 79/82%) and 4489 ng/mL for myoglobin (61/76%). Combined, these cut-offs increased sensitivity and negative predictive value to 89% (95% CI 81.3% to 94.4%) and 92% (95% CI 86.2% to 96.0%), respectively, suggesting potential for identification of both high-risk and low-risk patients at admission. Conclusions The myoglobin-to-CK ratio was the strongest early predictor of AKI. Combined with myoglobin ≥4489 ng/mL, a ratio ≥0.48 identified 89% of AKI cases and ruled out 92% of non-AKI cases, suggesting a potential admission-based tool for early AKI risk stratification in rhabdomyolysis. Trial registration number NCT04118608 .

• Sun, Hanqing; Hotvedt, Cecilie & Jacobsen, Dag (2024). Pasienter innlagt ved en medisinsk intensivavdeling etter henging 2010–21. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(11), s. 1–12. doi: 10.4045/tidsskr.23.0796. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn Henging er en av de vanligste dødsårsakene blant unge voksne i Norge. Vi ønsket å studere forløp under innleggelse og cerebral funksjon ved utskrivning hos pasienter innlagt i en medisinsk intensivavdeling etter henging uten skjelettskade. Materiale og metode Studien er basert på en retrospektiv gjennomgang av journaler for pasienter innlagt ved Medisinsk intensiv på Oslo universitetssykehus, Ullevål etter henging fra januar 2010 til desember 2021. Cerebral funksjon ved utskrivelse ble gradert med Cerebral Performance Category (CPC) fra grad 1 (normal cerebral funksjon) til 5 (hjernedød). Resultater I tidsperioden ble 135 pasienter innlagt i Oslo universitetssykehus etter henging. 60 ble innlagt i Medisinsk intensiv og inkludert i studien. Av disse var 35 menn og 25 kvinner. Psykisk sykdom var beskrevet i journalen hos 43 pasienter, somatisk sykdom hos 24, kjent rushistorikk hos 19 og tidligere selvmordsforsøk hos 19. Ved innleggelse hadde 34 pasienter hatt hjertestans og 39 hadde Glasgow Coma Scale-skår (GCS) på 3. Den vanligste komplikasjonen var pneumoni (n = 42). 27 pasienter (45 %) døde, samtlige hadde GCS-skår på 3 ved innkomst, og 25 hadde prehospital hjertestans. Ti ble organdonorer. 28 av de 33 overlevende hadde CPC-skår på 1 og fem pasienter hadde CPC-skår på 2 ved utskrivelse. Median laktatkonsentrasjon ved innkomst hos de som døde, var 8,1 mmol/L versus 3,8 mmol/L hos de overlevende. Fortolkning Henging er forbundet med høy dødelighet. Hjertestans, GCS-skår på 3 og laktacidose var vanligere blant de som døde, enn blant de overlevende. Organdonasjonsraten var høy, og de fleste overlevende hadde god cerebral funksjon vurdert ved CPC-skår.

• McMartin, Kenneth; Jacobsen, Dag & Hovda, Knut Erik (2024). Antidotes for poisoning by alcohols that form toxic metabolites. British Journal of Clinical Pharmacology. ISSN 0306-5251. doi: 10.1111/bcp.16232. Fulltekst i vitenarkiv
• Persett, Per Sverre; Bjørnaas, Mari Asphjell; Jacobsen, Dag; Ekeberg, Øivind & Myhren, Hilde (2023). Health-related quality of life in patients discharged from hospital after suicide attempt with violent methods compared to self-poisonings. Nordic Journal of Psychiatry. ISSN 0803-9488. 78(1), s. 37–45. doi: 10.1080/08039488.2023.2257686. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Suicide attempts by violent methods (VM) can leave the patient with physical and mental trauma affecting health-related quality of life (HRQOL). There is limited knowledge about the impact and HRQOL after a suicide attempt by VM. Aims To compare HRQOL in patients after a suicide attempt by VM, both to self-poisonings (SP) and the general population, and the association of hospital anxiety and depression to the HRQOL in the two groups. Methods Patients admitted to hospital after a suicide attempt were included in this prospective cohort-study from 2010 to 2015. For HRQOL, Short Form Health Survey (SF-36), and Hospital anxiety and depression scale scores (HADS-A and HADS-D) were assessed during study follow-up. Results The VM-group scored lower HRQOL for the physical dimensions at 3 months (p<.05), compared to the SP group, and only role limitation physical at 12 months (p<.05). Both groups scored lower HRQOL than the general population (p < .05). At baseline, the VM group scored lower for HADS-A than the SP group (p < .05). Both groups had lower HADS scores one year after (p < .05). In multiple regression analyses, the HADS scores were associated with HRQOL in the VM-group (p < .05). SP group HADS scores were negatively associated with general health, vitality, social functioning, and mental health (p < .05). Conclusion Both groups scored lower for HRQOL than the general population, and the VM group had worse score than the SP group in physical dimensions. Both groups had less symptoms of anxiety and depression over time, but it`s association to HRQOL was strong.

• Hagberg, Guri; Ihle-Hansen, Håkon; Sandset, Else Charlotte; Jacobsen, Dag; Wimmer, Rolf Henning & Ihle-Hansen, Hege (2022). Long Term Cognitive Function After Cardiac Arrest: A Mini-Review. Frontiers in Aging Neuroscience. 14, s. 1–8. doi: 10.3389/fnagi.2022.885226. Fulltekst i vitenarkiv
• Lao, Yvonne Elisabeth; Heyerdahl, Fridtjof; Jacobsen, Dag & Hovda, Knut Erik (2022). An enzymatic assay with formate oxidase for point-of-care diagnosis of methanol poisoning. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 131(6), s. 547–554. doi: 10.1111/bcpt.13789. Fulltekst i vitenarkiv Vis sammendrag

  Gas chromatographic analysis for quantification of plasma methanol requires laboratory equipment and personnel, and it is typically unavailable in short time notice, especially in low- and middle-income countries. Detection of formate with the enzyme formate oxidase (FOX) is a promising method that can make the diagnosis of methanol poisoning simple and fast. The aims of this study were to test the sensitivity and specificity of a modified FOX-enzyme and to test the specificity of a point-of-care (POC)-model containing FOX-enzyme with samples from patients with metabolic acidosis. The sensitivity and specificity of FOX-enzyme in aqueous solution were evaluated with a spectrometer and by visual detection for colour change. Formate concentrations between 1 and 20 mmol/L were used to test sensitivity, and 18 potentially interfering substances were tested for specificity. The sensitivity of the FOX-enzyme was 100% and the specificity 97%. When specificity of the POC-model was tested, no false positives were detected. As such, the sensitivity and specificity of this modified FOX-enzyme for detection of formate were high. The results with this enzyme confirm the potential for its use in formate analysis as a fast diagnosis of methanol poisoning.

• Lao, Yvonne Elisabeth; Goffeng, Anne; Spillum, Barbro Johanne; Jacobsen, Dag; Nakstad, Espen Rostrup & Hovda, Knut Erik (2021). A survey of the antidote preparedness in Norwegian hospitals. European Journal of Hospital Pharmacy (EJHP). ISSN 2047-9956. s. 1–5. doi: 10.1136/ejhpharm-2020-002544. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Antidotes are an important part of the emergency preparedness in hospitals. In the case of a major chemical accident or a fire, large quantities of antidotes may be needed within a short period of time. For time-critical antidotes it is therefore necessary that they be immediately available. We wanted to evaluate the antidote preparedness in Norwegian hospitals as regards the national recommendations and compare this with other international guidelines. Methods A digital survey was sent to the 50 hospitals in Norway that treat acute poisonings. Of these, four hospitals are categorised as regional hospitals, 15 as large hospitals and 31 as small hospitals. Each hospital was asked which antidotes they stockpiled from a list of 35 antidotes. The financial costs (low, moderate, high) were added to an established efficacy scale to illustrate the cost-effectiveness of the different antidotes. Results The response rate was 100%. Eleven of fifty (22%) hospitals stockpiled all antidotes recommended for their hospital size. All four regional hospitals had all the recommended antidotes. Large hospitals which were not regional hospitals had the least availability of antidotes, and only one large hospital stockpiled all antidotes recommended for this hospital size. Conclusions We found varying compliance with the national recommendations for antidote storage in hospitals. To strengthen antidote preparedness, we recommend standardised European guidelines to support national guidelines.

• Engebretsen, Stine; Bogstrand, Stig Tore; Jacobsen, Dag & Rimstad, Rune (2021). Quality of care, resource use and patient outcome by use of emergency response team compared with standard care for critically ill medical patients in the emergency department: a retrospective single-centre cohort study from Norway. Emergency medicine. ISSN 0013-6654. 11(8), s. 1–9. doi: 10.1136/bmjopen-2020-047264. Fulltekst i vitenarkiv Vis sammendrag

  Objective The study aimed to investigate quality of care, resource use and patient outcome in management by an emergency response team versus standard care for critically ill medical patients in the emergency department (ED). The emergency response team was multidisciplinary and had eight members, with a registrar in internal medicine as team leader. Design Register-based retrospective cohort study. Setting Tertiary hospital in Norway. Participants The study included 1120 patients with National Early Warning Score 2 (NEWS2) 5–10 points from 2015 and 2016. Patients missing ≥3 NEWS2 part scores, &lt;18 years and with orders ‘Not for ICU’ or ‘Not for resuscitation’ were excluded. Outcome measures Quality of care: pain assessment documented, analgesics given within 20 min, complete set of vital signs documented and antibiotics within 60 min if sepsis. Resource use: &gt;3 diagnostic interventions, critical care in the ED and ED length of stay (LOS) &lt;180 min. Patient outcome: intensive care unit (ICU) admission, ICU LOS &lt;66 hours, hospital LOS &lt;194 hours and mortality. Results The median age was 66 years, 53.5% were male, 44.3% were admitted to the ICU and the mortality rate was 10.6%. Altogether 691 patients received team management and 429 standard care. Team management had a positive association with ‘complete set of vital signs documented’ (OR 1.720, CI 1.254 to 2.360), ‘analgesics given within 20 minutes’ (OR 3.268, CI 1.375 to 7.767) and ‘antibiotics within 60 minutes if sepsis’ (OR 7.880, CI 3.322 to 18.691), but a negative association with ‘ pain assessment documented’ (OR 0.068, CI 0.037 to 0.128). Team management was also associated with ‘critical care in the ED’ (OR 9.900, CI 7.127 to 13.751), ‘ED LOS &lt;180 min’ (OR 2.944, CI 2.070 to 4.187), ‘ICU admission’ (OR 2.763, CI 1.962 to 3.891) and ‘mortality’ (OR 1.882, CI 1.142 to 3.102). Conclusions Team management showed positive results for quality of care and resource use. The results for later outcomes such as mortality, ICU LOS and hospital LOS were more ambiguous.

• Vibeto, Jon Hjellum; Vallersnes, Odd Martin; Dobloug, Andrea; Brekke, Mette; Jacobsen, Dag & Ekeberg, Øivind [Vis alle 7 forfattere av denne artikkelen] (2021). Treating patients with opioid overdose at a primary care emergency outpatient clinic: a cost-minimization analysis. Cost Effectiveness and Resource Allocation. 19(1), s. 1–12. doi: 10.1186/s12962-021-00303-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Treating patients with acute poisoning by substances of abuse in a primary care emergency clinic has previously been shown to be a safe strategy. We conducted an economic evaluation of this strategy compared to hospital treatment, which is the usual strategy. Methods Assuming equal health outcomes, we conducted a cost-minimization analysis. We constructed a representative opioid overdose patient based on a cohort of 359 patients treated for opioid overdose at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) from 1.10.2011 to 30.9.2012. Using a health care system perspective, we estimated the expected resources used on the representative patient in primary care based on data from the observed OAEOC cohort and on information from key informants at the OAEOC. A likely course of treatment of the same patient in a hospital setting was established from information from key informants on provider procedures at Drammen Hospital, as were estimates of hospital use of resources. We calculated expected costs for both settings. Given that the treatments usually last for less than one day, we used undiscounted cost values. Results The estimated per patient cost in primary care was 121 EUR (2018 EUR 1.00 = NOK 9.5962), comprising 97 EUR on personnel costs and 24 EUR on treatment costs. In the hospital setting, the corresponding cost was 612 EUR, comprising 186 EUR on personnel costs, 183 EUR on treatment costs, and 243 EUR associated with intensive care unit admission. The point estimate of the cost difference per patient was 491 EUR, with a low-difference scenario estimated at 264 EUR and a high-difference scenario at 771 EUR. Conclusions Compared to hospital treatment, treating patients with opioid overdose in a primary care setting costs substantially less. Our findings are probably generalizable to poisoning with other substances of abuse. Implementing elements of the OAEOC procedure in primary care emergency clinics and in hospital emergency departments could improve the use of health care resources.

• Hovda, Knut Erik; Lao, Yvonne Elisabeth; Gadeholt, Gaut & Jacobsen, Dag (2021). Formate test for bedside diagnosis of methanol poisoning. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 129(1), s. 86–88. doi: 10.1111/bcpt.13597. Fulltekst i vitenarkiv
• Persett, Per Sverre; Ekeberg, Øivind; Jacobsen, Dag; Bjørnaas, Mari Asphjell & Myhren, Hilde (2021). Higher Suicide Intent in Patients Attempting Suicide with Violent Methods Versus Self-Poisoning: A Prospective Study from Norway. Crisis. ISSN 0227-5910. s. 1–8. doi: 10.1027/0227-5910/a000773. Fulltekst i vitenarkiv Vis sammendrag

  Abstract. Background: Suicidal intent for patients attempting suicide using violent methods (VMs) is assumed to be higher than for those using self-poisoning (SP), which may explain the higher mortality observed in follow-up studies. However, this has not been studied prospectively. Aims: We aimed to compare patients attempting suicide using VMs with those using SP regarding suicidal intent, suicidal ideation, depression, and hopelessness during hospital stay and after 1 year. Methods: Patients hospitalized after suicide attempt by VMs ( n = 80) or SP ( n = 81) completed the Beck scales for Suicide Intent, Suicide Ideation, Depression Inventory, and Hopelessness on admission and at the 12-month follow-up. Results: On admission, those using VMs had higher suicidal intent than those using SP ( M = 16.2 vs. 13.3, p &lt; .001), but lower depression scores ( M = 22.2 vs. 26.8, p &lt; .05). No significant differences were found in suicidal ideation ( M = 20.1 vs. 23.1) or hopelessness ( M = 10.1 vs. 11.9). At 12-month follow-up, depression scores decreased significantly for both groups, while hopelessness decreased only for the SP group. Limitations: The statistical power achieved was lower than intended. Conclusion: The higher levels of suicidal intent, but lower levels of depression, may indicate more impulsivity among people attempting suicide using VMs. Suicidal ideation was relatively stable.

• Lao, Yvonne Elisabeth; Vartdal, Trond; Frøyshov, Sten; Latimer, Brian; Kværner, Christiane & Mataric, Marija [Vis alle 11 forfattere av denne artikkelen] (2021). Fomepizole dosing during continuous renal replacement therapy–an observational study. Clinical Toxicology. ISSN 1556-3650. doi: 10.1080/15563650.2021.1980581. Fulltekst i vitenarkiv Vis sammendrag

  Background Fomepizole is the preferred antidote for treatment of methanol and ethylene glycol poisoning, acting by inhibiting the formation of the toxic metabolites. Although very effective, the price is high and the availability is limited. Its availability is further challenged in situations with mass poisonings. Therefore, a 50% reduced maintenance dose for fomepizole during continuous renal replacement therapy (CRRT) was suggested in 2016, based on pharmacokinetic data only. Our aim was to study whether this new dosing for fomepizole during CRRT gave plasma concentrations above the required 10 µmol/L. Secondly, we wanted to study the elimination kinetics of fomepizole during CRRT, which has never been studied before. Methods Prospective observational study of adult patients treated with fomepizole and CRRT. We collected samples from arterial line (pre-filter) = plasma concentration, post-filter and dialysate for fomepizole measurements. Fomepizole was measured using high-pressure liquid chromatography with a reverse phase column. Results Ten patients were included in the study. Seven were treated with continuous veno-venous hemodialysis (CVVHD) and three with continuous veno-venous hemodiafiltration (CVVHDF). Ninety-eight percent of the plasma samples were above the minimum plasma concentration of 10 µmol/L. Fomepizole was removed during CRRT with a median saturation/sieving coefficient of 0.85 and dialysis clearance of 28 mL/min. Conclusion Fomepizole was eliminated during CCRT. The new dosing recommendations for fomepizole and CRRT appeared safe, by maintaining the plasma concentration above the minimum value of 10 µmol/L. Based on these data, the fomepizole maintenance dose during CRRT could be reduced to half as compared to intermittent hemodialysis.

• Lao, Yvonne Elisabeth; Molden, Espen; Kringen, Marianne K.; Annexstad, Ellen Johanne; Sæverud, Håvard Andreassen & Jacobsen, Dag [Vis alle 7 forfattere av denne artikkelen] (2020). Fatal liver failure after therapeutic doses of paracetamol in a patient with Duchenne muscular dystrophy and atypical pharmacogenetic profile of drug-metabolizing enzymes. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 127(1), s. 47–51. doi: 10.1111/bcpt.13389. Fulltekst i vitenarkiv Vis sammendrag

  Paracetamol has a good safety profile, but pharmacogenetic differences in drug-metabolizing enzymes may have an impact on its risk of hepatotoxicity. We present a case of fatal acute liver failure (ALF) after therapeutic doses of paracetamol in a patient with Duchenne muscular dystrophy, where pharmacogenetic screening was conducted. This 30-year-old man was electively admitted for a tracheostomy. A total of 14.5 g paracetamol was given over four days. He developed a severe ALF and died 11 days after admission. Pharmacogenetic screening showed absent CYP2D6 metabolism and increased CYP1A2 activity, which may have increased the formation of toxic intermediate metabolite, N-acetyl-p-benzo-quinone imine (NAPQI). He also had decreased function of UGT2B15, which increases the amount of paracetamol available for metabolism to NAPQI. Having a reduced muscle mass and thus a reduced glutathione levels to detoxify produced NAPQI may add to the risk of toxicity. This case may indicate that pharmacogenetic variability is of potential relevance for the risk of paracetamol-induced hepatotoxicity in patients with neuromuscular diseases. Further studies should investigate if pharmacogenetic screening could be a tool to detect potentially increased risk of hepatotoxicity in these patients at therapeutic doses of paracetamol, and hence provide information for selection of analgesic treatment.

• Engebretsen, Stine; Bogstrand, Stig Tore; Jacobsen, Dag & Rimstad, Rune (2020). Characteristics, management and outcome of critically ill general medical patients in the Emergency Department: An observational study. International Emergency Nursing. ISSN 1755-599X. 54:100939, s. 1–6. doi: 10.1016/j.ienj.2020.100939. Fulltekst i vitenarkiv Vis sammendrag

  Background Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients’ characteristics, ED management and outcome, and investigate factors associated with ICU admission. Methods The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used. Results 1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission. Conclusion More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were associated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial.

• Nakstad, Espen Rostrup; Stær-Jensen, Henrik; Wimmer, Rolf Henning; Henriksen, Julia; Alteheld, Lars Holger & REICHENBACH, ANTJE [Vis alle 17 forfattere av denne artikkelen] (2020). Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest – results of the prospective Norwegian Cardio-respiratory Arrest Study (NORCAST). Resuscitation. ISSN 0300-9572. 149, s. 170–179. doi: 10.1016/j.resuscitation.2019.12.031. Fulltekst i vitenarkiv
• Engebretsen, Stine; Bogstrand, Stig Tore; Jacobsen, Dag; Vitelli, Valeria & Rimstad, Rune (2020). NEWS2 versus a single-parameter system to identify critically ill medical patients in the emergency department. Resuscitation Plus. 3. doi: 10.1016/j.resplu.2020.100020. Fulltekst i vitenarkiv
• Tollisen, Karen Synnøve Hunting; Lund, Cathrine; Bjerva, Marianne; Dahl, Gry Torsæter; Högvall, Lisa Maria & Sandvik, Leiv [Vis alle 9 forfattere av denne artikkelen] (2020). Clinical impact of chronic substance abuse in a Norwegian ICU-population. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. s. 1–10. doi: 10.1111/aas.13766. Fulltekst i vitenarkiv Vis sammendrag

  Background The clinical impact of chronic substance abuse of alcohol and drugs—referred to as substance use disorders (SUD)—is often overlooked in the intensive care (ICU) setting. The aims of the present study were to identify patients with SUD—regardless of cause of admission—in a mixed Norwegian ICU‐population, and to compare patients with and without SUD with regard to clinical characteristics and mortality. Methods Cross‐sectional prospective study of a mixed medical and surgical ICU‐population aged ≥18 years in Oslo, Norway. Data were collected consecutively, using a questionnaire including the AUDIT‐C test, medical records and toxicology results. Patients classified with SUD were divided into the subgroups alcohol use disorders (AUD) and drug use disorders (DUD). Results Overall, 222 (26%) of the 861 patients included were classified with SUD; 137 (16%) with AUD and 85 (10%) with DUD. 130/222 (59%) of the SUD‐patients had substance abuse‐related cause of ICU‐admission. Compared to non‐SUD patients, DUD‐patients were younger (median age 42 vs 65 years) and had lower SAPS II scores (41 vs 46), while AUD‐patients had higher SOFA scores (8.0 vs 7.3). Overall, age‐adjusted logistic regression analysis showed similar hospital mortality for SUD‐patients and non‐SUD patients, but AUD was associated with increased mortality among medical patients and in patients with sepsis (OR 1.7 (95% CI 1.0‐2.8), and OR 2.6 (95% CI 1.1‐6.2)). Conclusion One in four ICU‐patients had SUD regardless of cause of admission. Alcohol use disorder was associated with increased mortality in medical patients and in patients with sepsis.

• Rimstad, Rune; Jacobsen, Dag & Bogstrand, Stig Tore (2020). NEWS2 versus a single-parameter system to identify critically ill medical patients in the emergency department. Resuscitation Plus. doi: 10.1016/j.resplu.2020.100020. Fulltekst i vitenarkiv
• Trydal, Elisabet; Martinsen, Anders B.; Beisland, Frode; Jacobsen, Dag & Holten, Aleksander Rygh (2019). Strukturert mottak av sepsispasienter og oppstart av antibiotika. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(9), s. 811–816. doi: 10.4045/tidsskr.18.0216. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Akuttmottaket ved Oslo universitetssykehus, Ullevål, innførte i 2017 en egen prosedyre for mottak av pasienter med mistenkt sepsis. Et strukturert sepsismottak skulle utløses hos disse pasientene, spesielt hvis minst to av tre kriterier i skåringsverktøyet Quick Sequential Organ Failure Assessment (qSOFA) var oppfylt. Vi ønsket å undersøke om tiltaket var hensiktsmessig for å oppfylle nasjonale anbefalinger om oppstart av antibiotika innen én time ved behandling av sepsis. MATERIALE OG METODE Voksne pasienter med mistenkt sepsis som ble tatt imot i strukturerte teammottak i perioden 15.5.–15.11.2017 ble inkludert. Det ble gjort en retrospektiv vurdering av om de inkluderte faktisk hadde hatt sepsis eller ikke. RESULTATER Det ble gitt antibiotika mot mistenkt sepsis i 216 strukturerte pasientmottak (172 sepsismottak og 44 medisinske teammottak). 175 (81 %) av pasientene fikk antibiotika innen den første timen i akuttmottaket. Mediantid fra ankomst til antibiotika ble igangsatt var 35 minutter. Bruk av qSOFA-skår alene fanget opp 80 (71 %) av de 112 pasientene som i ettertid ble klassifisert til å ha sepsis. FORTOLKNING Etter innføring av strukturert mottak av pasienter med mistenkt sepsis ble antibiotikabehandling i stor grad gitt innen én time.

• Hassanian-Moghaddam, Hossein; Zamani, Nasim; Roberts, Darren M.; Brent, Jeffrey; McMartin, Kenneth & Aaron, Cynthia [Vis alle 22 forfattere av denne artikkelen] (2019). Consensus statements on the approach to patients in a methanol poisoning outbreak. Clinical Toxicology. ISSN 1556-3650. s. 1–9. doi: 10.1080/15563650.2019.1636992. Fulltekst i vitenarkiv
• Vangstad, Marie; Bjørnaas, Mari Asphjell & Jacobsen, Dag (2019). Rhabdomyolysis: a 10-year retrospective study of patients treated in a medical department. European journal of emergency medicine. ISSN 0969-9546. 26(3), s. 199–204. doi: 10.1097/MEJ.0000000000000510. Fulltekst i vitenarkiv Vis sammendrag

  Background: Rhabdomyolysis is a common and potentially life-threatening syndrome, and acute kidney injury (AKI) is a serious complication. We performed a 10-year retrospective study that included all patients treated for rhabdomyolysis in a medical clinic. We examined the relationships between the levels of creatine kinase (CK), myoglobin, and creatinine (as a marker of renal function and thereby AKI), and whether the myoglobin/CK ratio could be a valuable tool in the clinical evaluation of this patient group. Clinical characteristics were noted. Patients and methods: The study included all patients treated for rhabdomyolysis in the Department of Medicine, Oslo University Hospital Ulleval, from 2003 to 2012. Rhabdomyolysis was defined as a serum CK activity more than five times the upper reference limit. Results: A total of 341 patients were included in the study; 51% developed AKI, and 20% of those required dialysis. Logistic regression showed that myoglobin concentration [P < 0.001, odds ratio (OR) = 6.24] was a better predictor than CK activity (P = 0.001, OR = 3.45) of the development of AKI. The myoglobin/CK ratio was a good predictor of AKI (P < 0.001, OR = 5.97). The risk of developing AKI increased with increasing myoglobin/CK ratio (P < 0.001); a ratio more than 0.2 was associated with an increased likelihood of developing AKI. Conclusion: Serum myoglobin concentration was a better predictor of AKI than was serum CK activity. The myoglobin/CK ratio may be useful for assessing the likelihood of developing AKI.

• Beitland, Sigrid; Wimmer, Rolf Henning; Lorentsen, Torleif; Jacobsen, Dag; Drægni, Tomas & Brunborg, Cathrine [Vis alle 9 forfattere av denne artikkelen] (2019). Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 63(5), s. 630–638. doi: 10.1111/aas.13316. Fulltekst i vitenarkiv Vis sammendrag

  Background The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients. Methods Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. For detection of VTE, Doppler ultrasound screening of neck, upper and lower extremity veins was used, and computed tomography angiography when clinically indicated for any medical reason. Results Among 70 included patients, 79% were males and mean age was 62 (±12.1) years. All received thromboprophylaxis with dalteparin, and 44 (63%) used graduated compression stockings. VTE was found in 19 (27%) patients; deep vein thrombosis in 15 (21%) and pulmonary embolism in 4 (6%). Among the VTEs, 11 (58%) presented within the first 48 hours after admission, two (11%) were located in the lower limbs and five (26%) were symptomatic. Risk factors for VTE in multivariable analyses were malignancy, abdominal surgery and SAPS II score <41 with an AuROC (95% CI) of 0.72 (0.58‐0.85, P = 0.01). Patients with and without VTE had comparable ICU LOS (13 vs 11 days, P = 0.27) and mortality (16% vs 20%, P = 0.72). Conclusion Venous thromboembolism was observed in 27% of ICU patients receiving thromboprophylaxis. Factors associated with increased risk of VTE were malignancy, abdominal surgery and SAPS II score <41. Presence of VTE did not impact on patient outcome.

• Tollisen, Karen Synnøve Hunting; Bjerva, Marianne; Dahl, Gry Torsæter; Meidell, Nina Knutrud; Sandvik, Leiv & Heyerdahl, Fridtjof [Vis alle 7 forfattere av denne artikkelen] (2019). Acute illness, Co-morbidity and Mortality in a Norwegian Intensive Care Population. International Journal of Anesthetics and Anesthesiology. ISSN 2377-4630. 6(1). doi: 10.23937/2377-4630/1410084. Fulltekst i vitenarkiv Vis sammendrag

  Background The need for intensive care beds is high and expected to increase. Descriptive studies of the intensive care population may reveal differences in predisposing factors and outcome within subgroups and help identify areas in need of increased prevention efforts. Objective To describe preadmission and clinical characteristics of an intensive care population in Oslo, and to compare the characteristics and outcomes of selected subgroups of this ICU-population. Method Prospective observational cohort study of intensive care patients aged ≥ 18, admitted to two hospitals in Oslo during a one-year period. Acute illness characteristics, comorbidity, limitations of life-sustaining treatment and hospital mortality were studied for the overall population and stratified for a) Gender and b) Medical and surgical patients within the age groups 18-59 years and 60 and above. Results We included 861 patients, 567 (66%) males; median age 63 years (range 18-95); 537 (62%) medical admissions and 324 (38%) surgical admissions. 632 (73%) received mechanical ventilation. Trauma (n = 191, 21%) and cardiovascular disease (n = 180, 20%) were the most common causes of admission. In patients aged 18-59, poisoning caused 56/217 (26%) of the medical admissions and medical patients had a higher prevalence of pre-existing chronic disease (157/217, 72% vs. 69/160, 43%) and Charlson comorbidity index (mean 2.0 vs. 0.7, p < 0.001) than surgical patients. In patients aged 60 and above, comorbidity was similar, but medical patients had a higher hospital mortality (143/320, 45% vs. 58/164, 34%, p < 0.05). 205 (24%) died in the ICU, and limitations of life-sustaining treatment were made in 183 (89%) cases 279(32%) died during the hospital stay. Of the 582 surviving patients 455 (78%) were discharged to home or rehabilitation, 88 (15%) to nursing homes and 39 (7%) to other institutions. Conclusion In patients younger than 60 years, trauma and poisoning were the most common causes of admission. Within this age group, medical patients had much higher prevalence of preexisting chronic disease than surgical patients, suggesting differences in predisposing factors. The majority of the surviving patients were discharged to home or to rehabilitation, indicating a low prevalence of futile intensive care.

• Tollisen, Karen Synnøve Hunting; Bjerva, Marianne; Lund, Cathrine; Dahl, Gry Torsæter; Högvall, Lisa Maria & Sandvik, Leiv [Vis alle 8 forfattere av denne artikkelen] (2019). Substance Abuse-Related Admissions in a mixed Norwegian Intensive Care Population. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. doi: 10.1111/aas.13506. Fulltekst i vitenarkiv Vis sammendrag

  Background Alcohol and drug abuse are potentially modifiable risk factors for critical illness. The aims of this study were to describe patients with substance abuse‐related admissions (abbreviated SARA) in a mixed intensive care (ICU) population in Oslo, and to compare these patients with patients with non‐SARA. Methods Cross‐sectional prospective study of a mixed medical and surgical ICU‐population in Oslo, Norway. Data were collected consecutively using a questionnaire, medical records, and toxicology results. SARA included admissions due to acute or chronic complications of alcohol or drug abuse, as well as substance abuse‐related injuries. Results Of the 852 patients included, 168 (20%) had SARA; 102 (12%) alcohol‐related and 66 (8%) drug‐related. Male patients aged 18‐39 had the highest proportion of SARA (47/97, 49%). Among the trauma patients, 69/182 (38%) were influenced by alcohol and drugs at the time of injury. Patients with SARA were significantly younger (median age 48 vs 66), had lower Charlson comorbidity index (mean 1.4 vs 2.5) and shorter length of stay (median days 2.4 vs 4.9), than non‐SARA patients. Hospital mortality was similar when adjusting for age (OR 0.8, P = .27, non‐SARA as reference). Conclusion Overall, one in five ICU admissions was associated with substance abuse. For male patients aged 18‐39 this ratio was nearly half. More than one third of the trauma patients were influenced by alcohol or drugs at time of injury.

• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2019). Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study. BMC Emergency Medicine. 19. doi: 10.1186/s12873-018-0219-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Though substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death. Methods All patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We collected data on gender, age, main toxic agent, suicidal intention, homelessness, history of severe mental illness, and self-discharge. Information on deaths was retrieved from the National Cause of Death Register. We did a multiple logistic regression analysis to look for associations between self-discharge and repeated poisoning and a Cox regression analysis for associations between self-discharge and death. Results During one year, 1731 patients were treated for 2343 episodes of acute poisoning by substances of abuse. Two-hundred-and-sixty-six (15%) patients self-discharged during at least one poisoning episode. Self-discharging patients were older, median age 39 years vs 32 years (p <  0.001), more frequently homeless, 20/266 (8%) vs 63/1465 (4%) (p = 0.035), and the main toxic agent more frequently was an opioid, 82/266 (31%) vs 282/1465 (19%) (p <  0.001). Self-discharge was an independent risk factor for repeated poisoning. The adjusted odds ratio for two or more poisoning episodes during one year among self-dischargers was 3.0 (95% CI 2.2–4.1). The association was even stronger for three or more poisoning episodes, adjusted odds ratio 5.0 (3.3–7.5). In total, there were 34 deaths, 9/266 (3.4%) among self-discharging patients and 25/1465 (1.7%) among patients not self-discharging (p = 0.12). The adjusted hazard ratio for death among self-discharging patients was 1.6 (0.75–3.6). Conclusions Self-discharge was associated with frequent poisonings by substances of abuse. Short-term mortality was doubled among self-discharging patients, though this increase was not statistically significant. Still, the increased risk of repeated poisoning marks self-discharging patients as a vulnerable group who might benefit from targeted post-discharge follow-up measures.

• Jørgensen, David; Tazmini, Kiarash & Jacobsen, Dag (2019). Acute Dysnatremias: a dangerous and overlooked clinical problem. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27(58). doi: 10.1186/s13049-019-0633-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Dysnatremias are common electrolyte disturbances with significant morbidity and mortality. In chronic dysnatremias a slow correction rate (<10 mmol/L/24 h) is indicated to avoid neurological complications. In acute dysnatremias (occurring <48 h) a rapid correction rate may be indicated. Most guidelines do not differ between acute and chronic dysnatremias. In this review, we focus on the evidence-based treatment of acute dysnatremias. Methods A literary search in PubMed and Embase. A total of 72 articles containing 79 cases were included, of which 12 cases were excluded due to lack of information. Results Of 67 patients (70% women) with acute dysnatremia, 60 had hypo- and 7 had hypernatremia. All patients with hyper- and 88% with hyponatremia had a rapid correction rate (> 10 mmol/L/24 h). The median time of correction was 1 day in patients with hypo- and 2.5 days in patients with hypernatremia. The mortality was 7% in patients with hypo- and 29% in patients with hypernatremia. Interpretation Severe acute dysnatremias have significant mortality and require immediate treatment. A rapid correction rate may be lifesaving and is not associated with neurological complications. Chronic dysnatremias, on the other hand, are often compensated and thus less severe. In these cases a rapid correction rate may lead to severe cerebral complications.

• Skaaland, Helene; Larstorp, Anne Cecilie Kjeldsen; Lindberg, Morten & Jacobsen, Dag (2019). Reference values for osmolal gap in healthy subjects and in medical inpatients. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. doi: 10.1080/00365513.2019.1672086. Fulltekst i vitenarkiv Vis sammendrag

  Methanol and ethylene glycol poisonings are associated with high morbidity and mortality rates if treatment is not initiated early. Since few hospitals measure these toxic alcohols on a 24/7 basis, calculation of the osmolal gap (OG) is an important diagnostic tool. The reference value for the OG lacks consensus. We, therefore, wanted to update the reference value for OG in presumed healthy subjects and study OG values in internal medicine patients. The OG was calculated in 285 patients at the Medical Clinic at Oslo University Hospital, and in 118 healthy blood donors at Vestfold Hospital Trust. OG was calculated by the formula: OG = Measured osmolality − calculated osmolality ((1.86 × s-sodium + s-glucose + s-urea)/0.93) mOsm/kg H2O. In the patients, median OG was 0 mOsm/kg H2O (interquartile range −3 to 3 mOsm/kg H2O, range −16 to103 mOsm/kg H2O). When corrected for one outlier, the central 95% interval for OG was −10 to 20. The healthy blood donors had a median OG of −1 mOsm/kg H2O (interquartile range −3 to1 mOsm/kg H2O, range −13 to 8 mOsm/kg H2O). When corrected for outliers, the reference range was −6 to 5 mOsm/kg H2O. Based on results from a healthy population, we suggest a reference value for the OG of ≤5 mOsm/kg H2O, but also recommend, based on our results from medical inpatients, to keep today's practice for suspecting poisoning with toxic alcohols at an elevated OG of ≥20 mOsm/kg H2O.

• Drangsholt, Elise Rebekka; Vangstad, Marie; Zakharov, Sergey; Hovda, Knut Erik & Jacobsen, Dag (2018). The hypothesis of circulus hypoxicus and its clinical relevance in patients with methanol poisoning - An observational study of 35 patients. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 123(6), s. 749–755. doi: 10.1111/bcpt.13074. Fulltekst i vitenarkiv
• Persett, Per Sverre; Grimholt, Tine Kristin; Ekeberg, Øivind; Jacobsen, Dag & Myhren, Hilde (2018). Patients admitted to hospital after suicide attempt with violent methods compared to patients with deliberate self-poisoning -a study of background variables, somatic and psychiatric health and suicidal behavior. BMC Psychiatry. 18:21, s. 1–10. doi: 10.1186/s12888-018-1602-5. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2018). Factors associated with rapidly repeated acute poisoning by substances of abuse: a prospective observational cohort study. BMC Research Notes. 11, s. 1–4. doi: 10.1186/s13104-018-3834-3. Fulltekst i vitenarkiv Vis sammendrag

  Objective We have previously found that 9% of patients treated for acute poisoning by substances of abuse in a primary care emergency outpatient setting presented with a new poisoning within a week. We now identify factors associated with rapidly repeated acute poisoning by substances of abuse. Results In 169/1952 (9%) cases of acute poisoning by substances of abuse included consecutively from October 2011 through September 2012 at a primary care emergency outpatient clinic in Oslo, Norway, the patient re-presented within a week with a new poisoning. Homeless patients were more likely to re-present, adjusted odds ratio (AOR) 2.0 (95% confidence interval (CI) 1.3–3.2, p = 0.003), as were self-discharging patients, AOR 1.7 (95% CI 1.2–2.4, p = 0.007), and patients with an opioid as main toxic agent, AOR 1.5 (95% CI 1.0–2.3, p = 0.028). There was no statistically significant association between rapid re-presentation and severe mental illness or suicidal intention.

• Rein, Pernille Ursin; Jacobsen, Dag; Ormaasen, Vidar & Dunlop, Oona Borghild (2018). Pneumococcal sepsis requiring mechanical ventilation: Cohort study in 38 patients with rapid progression to septic shock. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 62(10), s. 1428–1435. doi: 10.1111/aas.13236. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2018). Mortality, morbidity and follow-up after acute poisoning by substances of abuse: a prospective observational cohort study. Scandinavian Journal of Public Health. ISSN 1403-4948. 47, s. 452–461. doi: 10.1177/1403494818779955. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Despite the excess mortality and morbidity associated with acute poisoning by substances of abuse, follow-up is frequently not organised. We assessed morbidity, including repeated poisoning, and follow-up after acute poisoning by substances of abuse through charting contacts with health services. We also charted short-term mortality. Methods: Patients 12 years and older treated for acute poisoning by substances of abuse at a primary care emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We retrieved information from national registers on fatalities, hospital admissions, and contacts at outpatient specialist health services and with general practitioners (GPs), during the 90 days following a poisoning episode. Results: We included 1731 patients treated for 2343 poisoning episodes. During the 90 days following the poisoning, 31% of the patients were treated at somatic hospitals, 9% admitted to psychiatric hospitals, 37% in treatment at outpatient psychiatric/addiction specialist health services, 55% saw their GP, while 34% had no follow-up. The short-term mortality rate was 2.0%, eight times higher than expected. Increasing age, suicidal intention, opioid poisoning, and severe mental illness were associated with increased risk of death. Increasing age, male gender, opioid poisoning, and severe mental illness were associated with repeated poisoning. Patients with increased risk of repeated poisoning were more likely to be in follow-up at outpatient specialist psychiatric/addiction services and in contact with their GP. Conclusions: Follow-up measures seem targeted to those most in need, though one out of three had none. The mortality rate calls for concern.

• Bjerva, Marianne; Berild, Dag & Jacobsen, Dag (2017). En veltrent mann med mekanisk aortaklaffog leggsmerter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(2), s. 113–116. doi: 10.4045/tidsskr.15.1337. Fulltekst i vitenarkiv
• Grimholt, Tine Kristin; Haavet, Ole Rikard; Jacobsen, Dag; Reitan, Håvard Johnsen & Ekeberg, Øivind (2017). “You Have To Be Healthy And Resourceful To Be Seriously Ill” An Open-Ended Question Study Of Patients Experiences Of Care After Deliberate Self-Poisoning. Suicidology Online. 8(20). Fulltekst i vitenarkiv
• Grimholt, Tine Kristin; Jacobsen, Dag; Haavet, Ole Rikard & Ekeberg, Øivind (2017). Lower suicide intention in patients with personality disorders admitted for deliberate self-poisoning than in patients with other diagnoses. Annals of General Psychiatry. 16(1). doi: 10.1186/s12991-017-0145-3. Fulltekst i vitenarkiv Vis sammendrag

  Background People with deliberate self-poisoning and personality disorders are in increased risk for suicide. Intention and psychiatric features are important factors in a psychiatric evaluation and for planning aftercare. Methods Patients admitted to medical departments after deliberate self-poisoning were studied (n = 117). Patients with personality disorder according to (ICD-10, F.60-69) were compared to patients with affective disorders, substance use disorders, and unknown psychiatric diagnosis on Beck Suicide Intention Scale (SIS), Beck Suicide Ideation Scale (BSI), Beck Hopelessness Scale (BHS), and Beck Depression Inventory (BDI). Results The mean suicide intention score (SIS) was significantly lower among patients with personality disorders compared with patients with other psychiatric diagnoses 10.2 (95% CI 8.1–12.4) vs. 14.6 (95% CI 12.7–16.4) (p = 0.040). The hopelessness scores (BHS) were significantly higher among patients with personality disorders 13.0 (95% CI 10.9–15.2) compared with patients with affective disorders 8.2 (95% CI 6.1–10.3) and substance use disorders 9.9 (95% CI 5.2–14.6) (p = 0.0014) and unknown psychiatric diagnoses 10.6 (95% CI 9.1–12.2). There were no significant differences between the groups on suicide ideation (BSI) and depression (BDI). Conclusions Although patients with personality disorders had lower suicide intention compared to patients with other psychiatric diagnoses, they reported significantly more hopelessness. This distinction is an important implication in the clinical assessment and planning of further treatment of DSP patients.

• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2016). Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 24(1). doi: 10.1186/s13049-016-0268-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Procedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC). Methods All patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry. Results There were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries. Conclusion The procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.

• Beitland, Sigrid; Nakstad, Espen Rostrup; Stær-Jensen, Henrik; Drægni, Tomas; Andersen, Geir Øystein & Jacobsen, Dag [Vis alle 9 forfattere av denne artikkelen] (2016). Impact of acute kidney injury on patient outcome in out-of-hospital cardiac arrest: a prospective observational study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 60(8), s. 1170–1181. doi: 10.1111/aas.12753. Fulltekst i vitenarkiv
• McMartin, Kenneth E.; Jacobsen, Dag & Hovda, Knut Erik (2016). Antidotes for poisoning by alcohols that form toxic metabolites. British Journal of Clinical Pharmacology. ISSN 0306-5251. 81(3), s. 505–515. doi: 10.1111/bcp.12824. Fulltekst i vitenarkiv
• Höjer, Jonas; Jacobsen, Dag; Neuvonen, Pertti J. & Rosenberg, Per H. (2016). Lipid rescue – efficacy and safety still unproven. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 119(4), s. 345–348. doi: 10.1111/bcpt.12607. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2016). Follow-up after acute poisoning by substances of abuse: a prospective observational cohort study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 34, s. 309–316. doi: 10.1080/02813432.2016.1207152. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To chart follow-up of patients after acute poisoning by substances of abuse, register whether patients referred to specialist health services attended, and whether patients contacted a general practitioner (GP) after the poisoning episode. Design: Observational cohort study. Setting: A primary care emergency outpatient clinic in Oslo, Norway. Subjects: Patients ≥12 years treated for acute poisoning by substances of abuse were included consecutively from October 2011 to September 2012. Main outcome measures: Follow-up initiated at discharge, proportion of cases in which referred patients attended within three months, and proportion of cases in which the patient consulted a GP the first month following discharge. Results: There were 2343 episodes of acute poisoning by substances of abuse. In 391 (17%) cases the patient was hospitalised, including 49 (2%) in psychiatric wards. In 235 (10%) cases the patient was referred to specialist health services, in 91 (4%) advised to see their GP, in 82 (3%) to contact social services, in 74 (3%) allotted place in a homeless shelter, and in 93 (4%) other follow-up was initiated. In 1096 (47%) cases, the patient was discharged without follow-up, and in a further 324 (14%), the patient self-discharged. When referred to specialist health services, in 200/235 (85%) cases the patient attended within three months. Among all discharges, in 527/1952 (27%) cases the patient consulted a GP within one month. When advised to see their GP, in 45/91 (49%) cases the patient did. Conclusion: Attendance was high for follow-up initiated after acute poisoning by substances of abuse.

• Vallersnes, Odd Martin; Bjørnaas, Mari Asphjell; Lund, Cathrine; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2016). Follow-up of young patients after acute poisoning by substances of abuse: a comparative cohort study at an emergency outpatient clinic. BMC Research Notes. 9. doi: 10.1186/s13104-016-2200-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Young patients with acute poisoning by substances of abuse have increased mortality rates in the long term. In Oslo, Norway, most of these patients are treated at the Oslo Accident and Emergency Outpatient Clinic. The majority were discharged without follow-up. In 2010, the clinic implemented an intervention program for patients under the age of 23 presenting with acute poisoning by substances of abuse. The intervention was a brief motivational interview with a social worker before discharge, followed by a telephone consultation. Patients in need of further follow-up were identified and referred. Our objective was to study short-term effects of the intervention program on referrals to follow-up and repetition rates of acute poisoning. Methods Comparative cohorts were derived from studies of acute poisoning at the Oslo Accident and Emergency Outpatient Clinic in 2003, 2008 and 2012. Two age groups of patients presenting with acute poisoning by substances of abuse were included: 16–22 years and 23–27 years. Patients in the pre-intervention cohorts of 2003 and 2008 were compared with patients of the same age in the post-intervention cohort of 2012. Repetition rates were estimated using survival analysis. In total, 1323 patients were included; 422 in the younger pre-intervention group, 366 in the younger post-intervention group, 288 in the older pre-intervention group, and 247 in the older post-intervention group. Overall, the major toxic agents were ethanol 823/1323 (62 %) and opioids 215/1323 (16 %). 719/1323 (54 %) patients were male. Results In the younger groups referrals to follow-up increased from 86/317 (27 %) to 156/366 (43 %) (p < 0.001) after the implementation of the program. Among the older patients, who were not included in the program, there was no significant change in referrals. There was no change in the repetition rate of acute poisoning in either age group. The program established contact with 225/366 (61 %) of the eligible patients. Conclusion More patients were referred to follow-up after the intervention. We expect this to have a beneficial effect on their substance use and reduce excess morbidity and mortality in the long term. There was no change in the repetition rate of poisoning.

• Stær-Jensen, Henrik; Nakstad, Espen Rostrup; Fossum, Eigil; Mangschau, Arild; Eritsland, Jan & Drægni, Tomas [Vis alle 9 forfattere av denne artikkelen] (2015). Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest. Circulation. Cardiovascular Interventions. ISSN 1941-7640. 8(10). doi: 10.1161/CIRCINTERVENTIONS.115.002784. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2015). Patients presenting with acute poisoning to an outpatient emergency clinic: a one-year observational study in Oslo, Norway. BMC Emergency Medicine. 15(18). doi: 10.1186/s12873-015-0045-2. Fulltekst i vitenarkiv Vis sammendrag

  Background In Oslo, the majority of patients with acute poisoning are treated in primary care, at an emergency outpatient clinic with limited diagnostic and treatment resources. We describe the poisonings currently seen in this setting. We compare our findings with previous studies, with special concern for the appearance of new toxic agents, and changes in overall numbers and patterns of poisoning. Methods Observational study. Patients above the age of 12 years presenting at Oslo Accident and Emergency Outpatient Clinic (Oslo Legevakt) with acute poisoning were included consecutively from October 2011 through September 2012. Physicians and nurses registered data on preset forms. Main outcome measures were toxic agents, age, sex, intention, referral and time of presentation. Results There were 2923 episodes of acute poisoning in 2261 patients. Median age of the patients was 32 years, and 1430 (63 %) were males. The most frequent toxic agents were ethanol in 1684 (58 %) episodes, heroin in 542 (19 %), benzodiazepines in 521 (18 %), amphetamine in 275 (9 %), fire smoke in 192 (7 %), gamma-hydroxybutyrate (GHB) in 144 (5 %), and cannabis in 143 (5 %). In 904 (31 %) poisonings there were more than one toxic agent. In 493 episodes (17 %), the patient was hospitalised, and in 60 episodes (2 %) admitted to a psychiatric ward. Most poisonings, 2328 (80 %), were accidental overdoses with substances of abuse, 276 (9 %) were suicide attempts, and 312 (11 %) were accidents. Among ethanol poisonings in patients above the age of 26 years, 685/934 (73 %) were in males, and 339/934 (36 %) presented during weekends. However, among ethanol poisonings in patients under the age of 26 years, 221/451 (49 %) were in females, and 297/451 (66 %) presented during weekends. Conclusions The poisonings treated in this primary care setting were mostly due to accidental overdoses with ethanol or other substances of abuse. There is a disconcerting weekend drinking pattern among adolescents and young adults, with young females presenting as often as young males with ethanol poisoning.

• Akopian, Maja; Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2015). Levekår i Oslos bydeler og legevaktbehandlet rusmiddelforgiftning. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135, s. 1943–1948. doi: 10.4045/tidsskr.15.0370. Fulltekst i vitenarkiv
• Hovda, Knut Erik; Gadeholt, Gaut; Evtodienko, Vladimir & Jacobsen, Dag (2015). A novel bedside diagnostic test for methanol poisoning using dry chemistry for formate. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 75(7), s. 610–614. doi: 10.3109/00365513.2015.1066847. Fulltekst i vitenarkiv
• Grimholt, Tine Kristin; Jacobsen, Dag; Haavet, Ole Rikard; Sandvik, Leiv; Jørgensen, Trond & Norheim, Astrid Berge [Vis alle 7 forfattere av denne artikkelen] (2015). Effect of systematic follow-up by general practitioners after deliberate self-poisoning: A randomised controlled trial. PLOS ONE. 10:e0143934(12). doi: 10.1371/journal.pone.0143934. Fulltekst i vitenarkiv Vis sammendrag

  Objective To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice. Design Randomised clinical trial with two parallel groups. Setting General practices in Oslo and the eastern part of Akershus County. Participants Patients aged 18–75 years admitted to hospital for DSP.We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge. Intervention The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98). Main Outcome Measures Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), selfreported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records. Results There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103). Conclusion Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in hospitals or EMAs. However, the total number of incidents of deliberate self-harm reported by the patients was significantly higher in the intervention group. Trial registration Trial registration ClinicalTrials.gov Identifier: NCT01342809

• Grimholt, Tine Kristin; Jacobsen, Dag; Haavet, Ole Rikard; Sandvik, Leiv; Jørgensen, Trond & Norheim, Astrid Berge [Vis alle 7 forfattere av denne artikkelen] (2015). Structured follow-up by general practitioners after deliberate self-poisoning. A randomized controlled trial. BMC Psychiatry. 15(245). doi: 10.1186/s12888-015-0635-2. Fulltekst i vitenarkiv Vis sammendrag

  Background: General Practitioners (GPs) play an important role in the follow-up of patients after deliberate self-poisoning (DSP). The aim was to examine whether structured follow-up by GPs increased the content of, adherence to, and satisfaction with treatment after discharge from emergency departments. Methods: This was a multicentre, randomised trial with blinded assignment. Five emergency departments and general practices in the catchment area participated. 202 patients discharged from emergency departments after DSP were assigned. The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations, accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment, assessing personal problems and suicidal ideation, and availability in the case of suicidal crisis. Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers (KUHR) and by questionnaires mailed to patients and GPs. After 3 and 6 months, the frequency and content of GP contact, and adherence to GP consultations and treatment in general were registered. Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale. Results: Patients in the intervention group received significantly more consultations than the control group (mean 6.7 vs. 4.5 (p = 0.004)). The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems (93.1 % vs. 59.4 % (p = 0.002)) and with the fact that the GP included them in medical decisions (87.5 % vs. 54. 8 % (p = 0.009)). The intervention group was significantly more satisfied with the treatment in general than the control group (79 % vs. 51 % (p = 0.026)). Conclusions: Guidelines and structured, enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice. Consistently with previous research, there is still a need for interventional studies

• Stær-Jensen, Henrik; Sunde, Kjetil; Olasveengen, Theresa M.; Jacobsen, Dag; Drægni, Tomas & Nakstad, Espen Rostrup [Vis alle 8 forfattere av denne artikkelen] (2014). Bradycardia during therapeutic hypothermia is associated with good neurologic outcome in comatose survivors of out-of-hospital cardiac arrest. Critical Care Medicine. ISSN 0090-3493. 42(11), s. 2401–2408. doi: 10.1097/CCM.0000000000000515. Fulltekst i vitenarkiv
• Grimholt, Tine Kristin; Haavet, Ole Rikard; Jacobsen, Dag; Sandvik, Leiv & Ekeberg, Øivind (2014). Perceived competance and attitudes towards patients with suicidal behaviour: a survey of general practitioners, psychiatrists and internists. BMC Health Services Research. 14(208). doi: 10.1186/1472-6963-14-208. Fulltekst i vitenarkiv Vis sammendrag

  Background Competence and attitudes to suicidal behaviour among physicians are important to provide high-quality care for a large patient group. The aim was to study different physicians’ attitudes towards suicidal behaviour and their perceived competence to care for suicidal patients. Methods A random selection (n = 750) of all registered General Practitioners, Psychiatrists and Internists in Norway received a questionnaire. The response rate was 40%. The Understanding of Suicidal Patients Scale (USP; scores < 23 = positive attitude) and items about suicide in case of incurable illness from the Attitudes Towards Suicide Questionnaire were used. Five-point Likert scales were used to measure self-perceived competence, level of commitment, empathy and irritation felt towards patients with somatic and psychiatric diagnoses. Questions about training were included. Results The physicians held positive attitudes towards suicide attempters (USP = 20.3, 95% CI: 19.6–20.9). Internists and males were significantly less positive. There were no significant differences in the physicians in their attitudes toward suicide in case of incurable illness according to specialty. The physicians were most irritated and less committed to substance misuse patients. Self perceived competence was relatively high. Forty-three percent had participated in courses about suicide assessment and treatment. Conclusions The physicians reported positive attitudes and relatively high competence. They were least committed to treat patients with substance misuse. None of the professional groups thought that patients with incurable illness should be given help to commit suicide. Further customized education with focus on substance misuse might be useful.

• Lund, Cathrine; Bjørnaas, Mari Asphjell; Sandvik, Leiv; Ekeberg, Øivind; Jacobsen, Dag & Hovda, Knut Erik (2013). Five-year mortality after acute poisoning treated in ambulances, an Emergency outpatient clinic and hospitals in Oslo. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 21:65. doi: 10.1186/1757-7241-21-65. Fulltekst i vitenarkiv
• McMartin, Kenneth E.; Sebastian, C. Simon; Dies, David & Jacobsen, Dag (2012). Kinetics and metabolism of fomepizole in healthy humans. Clinical Toxicology. ISSN 1556-3650. 50(5), s. 375–383. doi: 10.3109/15563650.2012.683197. Fulltekst i vitenarkiv
• Lund, Cathrine; Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Hovda, Knut Erik (2012). Outpatient treatment of acute poisonings in Oslo : poisoning pattern, factors associated with hospitalization, and mortality. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 20, s. 10–10. doi: 10.1186/1757-7241-20-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Most patients with acute poisoning are treated as outpatients worldwide. In Oslo, these patients are treated in a physician-led outpatient clinic with limited diagnostic and treatment resources, which reduces both the costs and emergency department overcrowding. We describe the poisoning patterns, treatment, mortality, factors associated with hospitalization and follow-up at this Emergency Medical Agency (EMA, "Oslo Legevakt"), and we evaluate the safety of this current practice. Methods All acute poisonings in adults (> or = 16 years) treated at the EMA during one year (April 2008 to April 2009) were included consecutively in an observational study design. The treating physicians completed a standardized form comprising information needed to address the study's aims. Multivariate logistic regression analysis was used to identify the factors associated with hospitalization. Results There were 2348 contacts for 1856 individuals; 1157 (62%) were male, and the median age was 34 years. The most frequent main toxic agents were ethanol (43%), opioids (22%) and CO or fire smoke (10%). The physicians classified 73% as accidental overdoses with substances of abuse taken for recreational purposes, 15% as other accidents (self-inflicted or other) and 11% as suicide attempts. Most (91%) patients were treated with observation only. The median observation time until discharge was 3.8 hours. No patient developed sequelae or died at the EMA. Seventeen per cent were hospitalized. Gamma-hydroxybutyric acid, respiratory depression, paracetamol, reduced consciousness and suicidal intention were factors associated with hospitalization. Forty-eight per cent were discharged without referral to follow-up. The one-month mortality was 0.6%. Of the nine deaths, five were by new accidental overdose with substances of abuse. Conclusions More than twice as many patients were treated at the EMA compared with all hospitals in Oslo. Despite more than a doubling of the annual number of poisoned patients treated at the EMA since 2003, there was no mortality or sequelae, indicating that the current practice is safe. Thus, most low- to intermediate-acuity poisonings can be treated safely without the need to access hospital resources. Although the short-term mortality was low, more follow-up of patients with substance abuse should be encouraged.

• Paasma, Raido; Hovda, Knut Erik; Hassanian-Moghaddam, Hossein; Brahmi, Nozha; Afshari, Reza & Sandvik, Leiv [Vis alle 7 forfattere av denne artikkelen] (2012). Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes - a multicenter study. Clinical Toxicology. ISSN 1556-3650. 50(9), s. 823–831. doi: 10.3109/15563650.2012.728224. Fulltekst i vitenarkiv
• Grimholt, Tine Kristin; Bjørnaas, Mari Asphjell; Jacobsen, Dag; Dieserud, Gudrun Klemetsdal & Ekeberg, Øivind (2012). Treatment received, satisfaction with health care services, ansd psychiatric symptoms 3 months after hospitalization for self-poisoning. Annals of General Psychiatry. 11. doi: 10.1186/1744-859X-11-10. Fulltekst i vitenarkiv
• Lund, Cathrine; Drottning, Per; Stiksrud, Birgitte; Vahabi, Javad; Lyngra, Marianne & Ekeberg, Ivind [Vis alle 8 forfattere av denne artikkelen] (2012). A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 20(49). doi: 10.1186/1757-7241-20-49. Fulltekst i vitenarkiv
• Lund, Cathrine; Teige, Brita; Drottning, Per; Stiksrud, Birgitte; Rui, Tor Olav & Lyngra, Marianne [Vis alle 9 forfattere av denne artikkelen] (2012). A one-year observational study of all hospitalized and fatal acute poisonings in Oslo: Epidemiology, intention and follow-up. BMC Public Health. 12(1). doi: 10.1186/1471-2458-12-858. Fulltekst i vitenarkiv Vis sammendrag

  Background Up to date information on poisoning trends is important. This study reports the epidemiology of all hospitalized acute poisonings in Oslo, including mortality, follow-up referrals, and whether the introduction of over-the-counter sales of paracetamol outside pharmacies had an impact on the frequency of poisonings. Methods All acute poisonings of adults (≥16 years) treated at the five hospitals in Oslo from April 2008 to April 2009 were included consecutively in an observational cross-sectional multicentre study. A standardized form was completed by the treating physician, which covered the study aims. All deaths by poisoning in and outside hospitals were registered at the Institute of Forensic Medicine. Results There were 1065 hospital admissions of 912 individuals; 460 (50%) were male, and the median age was 36 years. The annual incidence was 2.0 per 1000. The most frequent toxic agents were ethanol (18%), benzodiazepines (15%), paracetamol (11%), and opioids (11%). Physicians classified 46% as possible or definite suicide attempts, 37% as accidental overdoses with substances of abuse (AOSA), and 16% as other accidents. Twenty-four per cent were discharged without any follow-up and the no follow-up odds were highest for AOSA. There were 117 deaths (eight in hospital), of which 75% were males, and the median age was 41 years. Thus, the annual mortality rate was 25 per 100 000 and the in-hospital mortality was 0.8%. Opioids were the most frequent cause of death. Conclusions The incidence of hospitalized acute poisonings in Oslo was similar to that in 2003 and there was an equal sex distribution. Compared with a study performed in Oslo in 2003, there has been an increase in poisonings with a suicidal intention. The in-hospital mortality was low and nine out of ten deaths occurred outside hospitals. Opioids were the leading cause of death, so preventive measures should be encouraged among substance abusers. The number of poisonings caused by paracetamol remained unchanged after the introduction of over-the-counter sales outside pharmacies and there were no deaths, so over-the-counter sales may be considered safe.

• TØMTE, ØYSTEIN; Andersen, Geir Øystein; Jacobsen, Dag; Drægni, Tomas; Auestad, Bjørn & Sunde, Kjetil (2011). Strong and weak aspects of an established post-resuscitation treatment protocol-A five-year observational study. Resuscitation. ISSN 0300-9572. 82(9), s. 1186–1193. doi: 10.1016/j.resuscitation.2011.05.003. Fulltekst i vitenarkiv
• Hovda, Knut Erik; Julsrud, Joar; Øvrebø, Steinar; Brørs, Odd & Jacobsen, Dag (2011). Studies on ethylene glycol poisoning: One patient - 154 admissions. Clinical Toxicology. ISSN 1556-3650. 49(6), s. 478–484. doi: 10.3109/15563650.2011.590140. Fulltekst i vitenarkiv Vis sammendrag

  Objective. Fomepizole is the antidote of choice in toxic alcohol poisonings. Potential side effects from frequent use of fomepizole were studied in a patient admitted 154 times with ethylene glycol (EG) poisoning. The intra-individual correlation between the serum-ethylene glycol (serum-EG) and the osmolal gap (OG) EG-kinetics, and other laboratory parameters were also studied. Methods. Combined pro- and retrospective collection of material from three different hospitals, and results from autopsy. Results. A 26-year-old female with a dissociative disorder was admitted with EG poisoning a total of 154 times. Her admission data revealed a median pH of 7.31 (range 6.87–7.49), pCO2: 4.2 kPa (1.2–6.7) (32 mmHg [9–50]), HCO–3: 15 mmol/L (4–26) (15 mEq/L [4–26]), base deficit (BD): 10 mmol/L (− 4 to 27) (10 mEq/L [–4 to 27]), serum-creatinine 65 μmol/L (40–133) (0.74 mg/dL [0.45–1.51]), OG 81 mOsm/kgH2O (25–132), and serum-EG 44 mmol/L (4–112) (250 mg/dL [25–700]). She was treated with fomepizole 99 times, ethanol 60 times (with a combination of both six times), and dialysis 73 times. The correlation between serum-EG and OG was good (r2 = 0.76). She was finally found dead outside hospital with an EG blood concentration of 81 mmol/L (506 mg/dL). An autopsy revealed calcium oxalate crystals in the kidneys, slight liver steatosis, and slight edema of the lungs. Discussion. The frequent use of fomepizole in this young patient was not associated with any detectable side effects; neither on clinical examination and lab screening, nor on the later autopsy. Regarding the sequelae from the repetitive EG-poisoning episodes, her kidney function seemed to normalize after each overdose. She was treated with buffer and antidote without hemodialysis 81 times without complications, supporting the safety of this approach in selected cases.

• TØMTE, ØYSTEIN; Drægni, Tomas; Mangschau, Arild; Jacobsen, Dag; Auestad, Bjørn & Sunde, Kjetil (2011). A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors. Critical Care Medicine. ISSN 0090-3493. 39(3), s. 443–449. doi: 10.1097/CCM.0b013e318206b80f. Fulltekst i vitenarkiv
• Kolvik, Hallgeir; Bjørnaas, Mari Asphjell; Hovda, Knut Erik; Jacobsen, Dag; Ekeberg, Øivind & Heyerdahl, Fridtjof (2011). Levekår og forgiftningsmønster i Oslos bydeler. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 131, s. 1424–1428. doi: 10.4045/tidsskr.10.0531. Fulltekst i vitenarkiv
• Bjørnaas, Mari Asphjell; Teige, Brita; Hovda, Knut Erik; Ekeberg, Øivind; Heyerdahl, Fridtjof & Jacobsen, Dag (2010). Fatal poisonings in Oslo: A one-year observational study. BMC Emergency Medicine. 10(6), s. 10–13. doi: 10.1186/1471-227X-10-13. Fulltekst i vitenarkiv Vis sammendrag

  Background Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Methods Fatal and non-fatal acute poisonings in subjects aged ≥16 years in Oslo (428 198 inhabitants) were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic), and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. Results In Oslo, during the one-year period studied, 103 subjects aged ≥16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years). In 92 cases (89%), death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases), followed by ethanol (9%), tricyclic anti-depressants (TCAs) (4%), benzodiazepines (4%), and zopiclone (4%). Seventy-one (69%) were evaluated as accidental deaths and 32 (31%) as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04). Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91), 14% (95% C.I., 0.04-0.33), and 10% (95% C.I., 0.02-0.27), respectively. Conclusions Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental deaths. Although case fatality rates were highest for methanol, TCAs, and antihistamines, most deaths were caused by opiates or opioids.

• TØMTE, ØYSTEIN; Drægni, Tomas; Mangschau, Arild; Jacobsen, Dag; Auestad, Bjørn H. & Sunde, Kjetil (2010). A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors. Critical Care Medicine. ISSN 0090-3493. doi: 10.1097/CCM.0b013e318206b80f. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Knutsen, Ane Kühmstedt; Dunlop, Oona Borghild; Jacobsen, Dag; Glæserud, Pernille & Wibetoe, Grunde (2025). Methemoglobinemi etter lokalanestesi. doi: 10.4045/tidsskr.24.0399. Fulltekst i vitenarkiv
• Olsen, Jul Eirik; Vandsemb, Esten Nymoen; Treider, Martin Alavi; Gjertsen, Marit & Jacobsen, Dag (2024). Vedvarende hikke etter perforert kolecystitt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(1), s. 1–6. doi: 10.4045/tidsskr.23.0437. Fulltekst i vitenarkiv
• Husby, Maren Wennberg; Bjørnsen, Lars Petter Bache-Wiig; Jørgensen, Arve; Lassen, Tone Merete; Jacobsen, Dag & Laugsand, Lars Erik (2024). Feildosering av metotreksat. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(6), s. 1–5. doi: 10.4045/tidsskr.23.0657. Fulltekst i vitenarkiv Vis sammendrag

  En eldre kvinne ble henvist til akuttmottaket på grunn av økende tungpustethet de siste tre ukene. Feiladministrering av metotreksat var årsaken til plagene.

• Hovda, Knut Erik & Jacobsen, Dag (2024). Comment on “Elevated osmol gaps in patients with alcoholic ketoacidosis”. Clinical Toxicology. ISSN 1556-3650. doi: 10.1080/15563650.2024.2433122. Fulltekst i vitenarkiv
• Jacobsen, Dag (2023). En gass til lyst og besvær. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(1). doi: 10.4045/tidsskr.22.0735. Fulltekst i vitenarkiv
• Mjølstad, Ole Christian; Radtke, Maria Anita; Brodtkorb, Eylert; Edvardsen, Frode; Rødseth, Brede Wenche & Aamo, Trond Oskar [Vis alle 9 forfattere av denne artikkelen] (2023). Recurrent malignant ventricular arrhythmias and paresthesia—a mystery revealed as aconitine poisoning: a case report. Journal of Medical Case Reports. doi: 10.1186/s13256-023-04304-2. Fulltekst i vitenarkiv Vis sammendrag

  Background: We report a case of a clinical challenge lasting for 12 months, with severe and unresolved clinical features involving several medical disciplines. Case presentation: A 53-year-old Caucasian male, who had been previously healthy apart from a moderate renal impairment, was hospitalized 12 times during a 1-year period for a recurrent complex of neurological, cardiovascular, and gastrointestinal symptoms and signs, without any apparent etiology. On two occasions, he suffered a cardiac arrest and was successfully resuscitated. Following the first cardiac arrest, a cardiac defibrillator was inserted. During the 12th admission to our hospital, aconitine poisoning was suspected after a comprehensive multidisciplinary evaluation and confirmed by serum and urine analyses. Later, aconitine was also detected in a hair segment, indicating exposure within the symptomatic period. After the diagnosis was made, no further episodes occurred. His cardiac defibrillator was later removed, and he returned to work. A former diagnosis of epilepsy was also abandoned. Criminal intent was suspected, and his wife was sentenced to 11 years in prison for attempted murder. To make standardized assessments of the probability for aconitine poisoning as the cause of the eleven prior admissions, an “aconitine score” was established. The score is based on neurological, cardiovascular, gastrointestinal, and other clinical features reported in the literature. We also make a case for the use of hair analysis to confirm suspected poisoning cases evaluated after the resolution of clinical features. Conclusion: This report illustrates the medical challenge raised by cases of covert poisoning. In patients presenting with symptoms and signs from several organ systems without apparent cause, poisoning should always be suspected. To solve such cases, insight into the effects of specific toxic agents is needed. We present an “aconitine score” that may be useful in cases of suspected aconitine poisoning.

• Kvåle, Gunnar; Gilbert, Mads; Klein, Jørn; Svanæs, Dag; Jacobsen, Dag & Eldjarn, Knut [Vis alle 7 forfattere av denne artikkelen] (2021). «Slå ned» og hold nede til befolkningen er vaksinert! Fulltekst i vitenarkiv Vis sammendrag

  https://www.vg.no/nyheter/meninger/i/qAvGWg/slaa-ned-og-hold-nede-til-befolkningen-er-vaksinert?

• Jacobsen, Dag; Gilbert, Mads; Kvåle, Gunnar & Klein, Jørn (2021). Ny nedstenging må til om mutert virus skal slås ned! Fulltekst i vitenarkiv Vis sammendrag

  https://www.vg.no/nyheter/meninger/i/M3Ej8o/ny-nedstenging-maa-til-om-mutert-virus-skal-slaas-ned?

• Jacobsen, Dag; Gilbert, Mads & Kvåle, Gunnar (2021). Vi trenger nasjonale tiltak nå! Fulltekst i vitenarkiv Vis sammendrag

  https://www.vg.no/nyheter/meninger/i/2dqE1a/vi-trenger-nasjonale-tiltak-naa

• Klein, Jörn; Hasle, Gunnar; Eldjarn, Knut; Jacobsen, Dag; Svanæs, Dag & Nyborg, Gunhild Alvik [Vis alle 7 forfattere av denne artikkelen] (2020). Flokkimmunitet uten smittevern og vaksine er en farlig korona-strategi. Fulltekst i vitenarkiv
• Kvåle, Gunnar; Flaatten, Hans; Gilbert, Mads & Jacobsen, Dag (2020). Korona kan stoppes med enda strengere tiltak. Fulltekst i vitenarkiv
• Vibeto, Jon Hjellum; Vallersnes, Odd Martin; Dobloug, Andrea; Brekke, Mette; Jacobsen, Dag & Ekeberg, Øivind [Vis alle 7 forfattere av denne artikkelen] (2020). Treating patients with opioid overdose at a primary care emergency outpatient clinic: a cost-minimization analysis. Fulltekst i vitenarkiv
• Svanæs, Dag; Kvåle, Gunnar; Andersen, Bjørg Marit; Eldjarn, Knut; Klein, Jørn & Hasle, Gunnar [Vis alle 11 forfattere av denne artikkelen] (2020). Ti myter om pandemien. s. 38–39. Fulltekst i vitenarkiv
• Flaaten, Hans; Gilbert, Mads; Kvåle, Gunnar; Jacobsen, Dag & Svanæs, Dag (2020). Sterkere tiltak - Ikke letteler. VG : Verdens gang. ISSN 0805-5203. Fulltekst i vitenarkiv Vis sammendrag

  https://www.vg.no/nyheter/meninger/i/4qeRX9/sterkere-tiltak-ikke-lettelser

• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2018). Morbidity and follow-up after acute poisoning by substances of abuse. Fulltekst i vitenarkiv
• Vangstad, Marie; Bjørnaas, Mari Asphjell & Jacobsen, Dag (2018). Treningsindusert rabdomyolyse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(1), s. 10–10. doi: 10.4045/tidsskr.17.1079. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2017). Patients self-discharging during treatment for acute poisoning by substances of abuse. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2017). Factors associated with rapidly repeating acute poisoning by substances of abuse. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2016). Outpatient treatment of acute poisoning by substances of abuse: a 1-year prospective observational study. Fulltekst i vitenarkiv
• Hovda, Knut Erik; Gadeholt, Gaut & Jacobsen, Dag (2016). Ethanol strips for monitoring of ethanol concentrations during treatment of toxic alkohol: preliminary results. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Bjørnaas, Mari Asphjell; Lund, Cathrine; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2016). Follow-up of young patients after acute poisoning by substances of abuse: a comparative cohort study at an emergency outpatient clinic. Fulltekst i vitenarkiv
• Rimul, Gunnar; Kormeset, Per Olav; Jacobsen, Dag; Hortemo, Sigurd & Ulshagen, Karen Marie (2015). Fortsatt salg av paracetamol i butikk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(4), s. 316–317. doi: 10.4045/tidsskr.14.1563. Fulltekst i vitenarkiv
• Stær-Jensen, Henrik; Nakstad, Espen Rostrup; Fossum, E; Mangschau, Arild; Eritsland, Jan & Jacobsen, Dag [Vis alle 8 forfattere av denne artikkelen] (2014). Emergency coronary angiography and revascularization in patients with out of hospital cardiac arrest - relation to post - ROSC ECG - a prospective observational study. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2014). Akutte forgiftninger ved Legevakten i Oslo: en ett-års observasjonsstudie. Fulltekst i vitenarkiv
• Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Brekke, Mette (2014). Patients presenting with acute poisoning to an outpatient emergency clinic in Oslo: a one year prospective observational study. Fulltekst i vitenarkiv
• Paasma, Raido; Hovda, Knut Erik; Hassanian-Moghaddan, H; Brahmi, Nozha; Afshari, Reza & Sandvik, Leiv [Vis alle 7 forfattere av denne artikkelen] (2013). Response to the letter "Risk assessment of methanol poisoning in outbreaks not applicable to isolated cases". Clinical Toxicology. ISSN 1556-3650. 51(2), s. 120–120. doi: 10.3109/15563650.2013.764430. Fulltekst i vitenarkiv
• Heyerdahl, Fridtjof; Bjørnaas, Mari Asphjell; Lund, Cathrine; Jacobsen, Dag & Ekeberg, Øivind (2013). Long-term follow-up of three cohorts of self-poisoning. Clinical Toxicology. ISSN 1556-3650. 51(4), s. 254–254. Fulltekst i vitenarkiv
• Lund, Caroline; Hovda, Knut Erik; Gudmundsdottir, Helga; Andersson, Kirsti Svendsen; NYVOLD, CECILIE & Froyshov, Sten [Vis alle 8 forfattere av denne artikkelen] (2013). Severe metformin-induced lactic acidosis: Case series of 10 patients. Clinical Toxicology. ISSN 1556-3650. 51(4), s. 365–365. Fulltekst i vitenarkiv
• Paasma, Raido; Hovda, Knut Erik; Hassanian-Moghaddan, H; Brahmi, Nozha; Afshari, Reza & Jacobsen, Dag (2012). Risk Assessment Score for Methanol Poisoning. Clinical Toxicology. ISSN 1556-3650. 50(4), s. 350–351. Fulltekst i vitenarkiv
• Heyerdahl, Fridtjof; Opdahl, Helge & Jacobsen, Dag (2012). The Role of the Norwegian Competence Centre for NBC Medicine during the Non-CBRN Terrorist Attacks in Norway on 22 July 2011. Clinical Toxicology. ISSN 1556-3650. 50(4), s. 276–276. Fulltekst i vitenarkiv
• Heyerdahl, Fridtjof; Haavind, Anniken & Jacobsen, Dag (2012). A Fatal Case of Suicidal Injection and Ingestion of Self-Extracted Ricin. Clinical Toxicology. ISSN 1556-3650. 50(4), s. 290–290. Fulltekst i vitenarkiv
• Hovda, Knut Erik; Refsum, Helge & Jacobsen, Dag (2012). A Case of Extraordinary High Serum-Venlafaxine and Prolonged Elimination without Genetic Predisposal. Clinical Toxicology. ISSN 1556-3650. 50(4), s. 324–325. Fulltekst i vitenarkiv
• Lund, Cathrine; Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind & Hovda, Knut Erik (2011). Acute poisonings treated at the outpatient accident and emergency clinic (EMA) in Oslo, 2008. Fulltekst i vitenarkiv
• BERG, THEA CHRISTINE SCHOU; Skjerdal, Jatrud W.; Muan, Berit & Jacobsen, Dag (2011). A Case Report Concerning Monochloroacetic Acid. Clinical Toxicology. ISSN 1556-3650. 49(3), s. 255–255. Fulltekst i vitenarkiv
• Spillum, Bjørg; Tosterud, M.; Nilssen, Dag Egil; Paulsen, Berit Smestad & Jacobsen, Dag (2011). Coma After Intake of an Unknown Plant Root - Unintentional Anticholinergic Intoxication. Clinical Toxicology. ISSN 1556-3650. 49(3), s. 231–231. Fulltekst i vitenarkiv
• Lund, Cathrine; Christensen, Hege Staaland; Frøyshov, Sten & Jacobsen, Dag (2010). Toxicokinetics of Diltiazem and Three Metabolites During Acute Life-Threatening Poisoning. Clinical Toxicology. ISSN 1556-3650. 48(3), s. 281–281. Fulltekst i vitenarkiv
• Bjørnaas, Mari Asphjell; Jacobsen, Eva-Marie & Jacobsen, Dag (2010). Non-fatal self-poisoning by LMW Heparin and the use of antidote. Thrombosis Research. ISSN 0049-3848. 126(5), s. e403–e405. doi: 10.1016/j.thromres.2010.08.026. Fulltekst i vitenarkiv

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