Clinical study of poisoned cases by some drugs admitted to the menoufia poisoning control center over 1 year (2011), with a focus on ECG changes

Abstract

ObjectiveThe aim of this work was to study ECG changes in cases of poisoning by digoxin, theophylline, and antidepressant overdose that were admitted to Menoufia Poisoning Control Center (MPCC) in 2011, with a focus on evaluation of ECG changes in correlation with both arterial blood gases and electrolyte changes, together with clinical manifestations.BackgroundNumerous drugs can cause ECG changes and lead to cardiac dysrhythmias, and the diagnoses and subsequent management of patients with ECG changes following poisonings can be a challenge for even the most experienced physician. Digoxin toxicity often presents with gastrointestinal side effects, cardiac dysrhythmias, and neurological effects. Overdoses of antidepressants are common and deadly, and sudden cardiovascular deterioration is the hallmark of toxicity. Theophylline overdose can lead to neurotoxicity and cardiac toxicity associated with life-threatening dysrhythmias.Patients and methodsIn this study, patients who had overdosed on digitalis, theophylline, and antidepressants admitted to MPCC in 2011 were included. Clinical data, serum electrolytes, arterial blood gas changes, and ECG changes were assessed.ResultsA total of 77 patients were studied. Most patients in the study were females in the age group of 20 to less than 40 years, and they outnumbered males in both suicidal and accidental modes. Theophylline overdose cases were the most common, followed by antidepressants and then digoxin overdose. A significant relation was found between the type of drug overdose and clinical manifestations, wherein vomiting occurred most frequently with digoxin overdose. Convulsions occurred only in cases of overdose with antidepressants. Hypokalemia was more evident in cases of overdose with antidepressants. In terms of ECG changes, sinus bradycardia and ST segment depression were found only in digoxin overdose cases. Sinus tachycardia occurred most frequently in theophylline overdose cases. A highly significant relation was found between potassium (K + ) blood-level and ECG changes such as sinus tachycardia and ST segment depression. A significant relation was found between metabolic acidosis and a wide QRS complex. No case fatality was recorded in this study.ConclusionDrug overdose is a major and longstanding source of morbidity worldwide. Digitalis overdose manifested as sinus bradycardia and ST segment depression. Theophylline overdose manifested as sinus tachycardia and antidepressant overdose cases were characterized by sinus tachycardia and a wide QRS complex.