Loghman-Hakim Hospital Poison Center Research Articles

The Trend of Poisoning During the COVID-19 and Post-COVID-19 Era in Tehran, Iran Between 2019 and 2023

Background: Each year, a significant number of fatalities caused by drug poisoning are documented globally. Analyzing the pattern of poisonings is crucial for prevention, particularly in decreasing the incidence of suicides. This research aimed to investigate the trend of poisonings from 2019 to 2023 at Loghman Hakim Hospital, Tehran, Iran.Methods: The present study collected data on gender, age, reasons for poisoning and patient outcomes from the archived records of Loghman Hakim Hospital Poison Center, Tehran, Iran, using the ICD- 10 coding system. Patients were categorized into medication groups following the guidelines in Goldfrank’s book and with input from clinical toxicology specialists. All records underwent a thorough review. The data were analyzed using SPSS software, version 24, incorporating statistical analyses, such as Fisher’s exact and chi-square tests. Result: A comprehensive analysis was performed on 81,689 patients who had experienced poisoning, with 41336(50.6%) being male and 40353(49.4%) being female. The mortality rate over five years stood at 2.01%. The highest number of fatalities occurred in 2023 and 2022, with 359 cases (21.82%) and 358 cases (21.76%), respectively. Opioid and narcotic poisoning was identified as the primary cause of death, representing 30.33% of the cases.Conclusion: It is crucial to restrict access to methadone and alcohol. Additionally, the increasing instances of poisonings underscore the societal requirement for government support to alleviate the psychological and economic burdens induced by the coronavirus pandemic.

Observational study of dermatological manifestations in patients admitted to a tertiary poison center in Iran

Background/aim: Acute unintentional and deliberate poisoning by medications and chemicals is a frequent emergency, especially in Iran. This study aimed to evaluate the frequency and character of skin findings occurring in patients with acute intentional and aunintentional poisoning. Materials and methods: This prospective observational study was performed at the Loghman Hakim Hospital Poison Center over a period of 6 months from April 2016 to September 2016. Data including patient demographics, cause of poisoning, and level of consciousness were collected. Pediatric patients (under the age of 13) and patients who died in the first hours of admission were excluded from the study. Results: The most common cause of toxicity-related admission in our patients was methadone overdose. The most common skin finding in these patients was xerosis. According to our results, there was an association between tramadol poisoning and self-induced lesions. Shin hyperpigmentation was found to be significantly more frequent in patients with lead poisoning. Conclusion: Further study is recommended to shed light on the possible association of drug poisoning and skin lesions.

Survey on Hypothermia and Hyperthermia in Poisoned Patients in a Unique Referral Hospital, Tehran, Iran.

BackgroundBody temperature is a critical criterion of health. Drugs and a variety of poisons can affect body temperature in poisoned patients, causing hyperthermia and hyperpyrexia.ObjectivesOur previous study’s findings in patients poisoned with organophosphate led us to the goal of this study: obtaining the initial tympanic temperature in patients poisoned by a variety of toxins.Materials and MethodsA cross-sectional study reviewed the records of poisoned patients who were admitted to the toxicological intensive care unit (TICU) at Loghman Hakim hospital poison center (LHHPC) from February 2014 to February 2015. The data collected included gender, age, type of poisoning, the season during which poisoning occurred, vital signs, initial tympanic temperature (first four hours), presence of seizures, white blood cell (WBC) count, creatinine phosphokinase (CPK), length of stay and patient outcome. We determined the mean (SD) for normally distributed continuous variables, the median and interquartile range for non-normally distributed continuous variables, and the absolute and relative frequency (%) for categorical variables. All were determined using SPSS version 16.ResultsData were collected from 310 eligible patients. The mean patient age was 32.65 (with a standard deviation of 14.40). Of the patients in the study, 183 (59%) were male. Intentional poisoning in an attempted suicide was documented in 253 (81.6%) patients. The most prevalent poisoning agent was aluminum phosphate (18.70%), followed by methadone (10%) and opium (10%). Seventy percent of the patients (n = 217) were diagnosed and classified with fever or hyperthermia. A temperature ≥ 40°C was detected in just three cases. The highest mean temperature was found in patients poisoned with amphetamine, organophosphate and tramadol. Patients with alcohol and phenobarbital poisoning were included in the sample, but these patients were not diagnosed with hypothermia. WBC ≥ 10,000 cells/mL and CPK ≥ 975 IU/L were recorded in 57.7% and 13.2% of subjects, respectively.ConclusionsBody temperature changes in human poisonings are a matter in need of special attention. A literature review did not reveal any controversy over hypothermia, but poisoning cases exhibit a variety of patterns of fever and hyperthermia. If there are no limits to the diagnosis of fever and hyperthermia, all cases with a poor prognosis which fail to respond to treatment could be categorized as drug-induced hyperthermia. Therefore, a different approach is needed for poisoning cases.

Methadone Related Poisoning on the Rise in Tehran, Iran

Background: In Iran, methadone has been used for methadone maintenance treatment (MMT) as well as analgesic treatment in pain clinics. Recently, there are some reports regarding accidental and intentional methadone poisonings and deaths. The aim of this study was to evaluate the trend of methadone poisonings and deaths during a 10-year period in Tehran, Iran. Methods: This was a retrospective cross-sectional study over 2000 to 2010. Patients with a documented methadone poisoning who were admitted in Loghman Hakim Hospital Poison Center in Tehran, Iran were identified and included in the study. The data including patients’ age, gender, ingested dose, co-ingestants, intention of ingestion and outcome were extracted from the patients’ medical records. Results: During the study period, 1426 cases of methadone poisoning were recorded, of which, 1041 cases (73%) were men. Thirty-six cases (2.5%) died. Mean age of the patients was 29.9 ± 17 years. In 476 cases, the intention of poisoning could not be determined, and in the remaining, the intention was misuse (n = 273, 28.7%), suicide (n = 254, 26.7%), accidental (n = 245, 25.8%) and abuse (n = 178, 18.8%). Mean of the ingested dose of methadone was 120.6 ± 306.8 mg. The incidence of acute methadone poisoning per one million population of Tehran was 0.43 in 2000 that rose to 37.62 in 2010. Conclusion: The results indicate that methadone poisoning and deaths have increased in Tehran. MMT clinics should be strictly run according to the national guideline to prevent methadone poisoning. With regard to high frequency of poly-drug use in methadone poisoning, it seems important to warn health care providers against prescription of other drugs with methadone.

Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011.

The aim of this study was to determine the frequency of each poisoning and its related death in our center as a sample of Tehran in six consecutive years (2006 to 2011). All poisoned children and adults referring to Loghman-Hakim hospital poison center and hospitalized in the study period were enrolled and evaluated. In 108,265 patients, the most common causes of poisoning were anti-epileptics and sedative-hypnotics (22.3%). The most common causes of death were pesticides (24.84%) and narcotics (24.75%). In drugs of abuse, opium was more prevalent in the early period of the study but was replaced by methadone later. It seems that national policies for drug control and prevention of suicide have not been efficient enough. We expect to see Iran in the first 50 countries with regard to suicide and to maintain the first place in narcotic abuse if enough attention is not provided.

Evaluation of Clinical and Biochemical Variables in Acute Methanol Poisoning: Is blood pH a Good Prognostic Factor for Prediction of Outcome?

Background: Acute methanol poisoning is one of the most important chemical poisoning due to drinking of illegal and handmade alcoholic beverages in Iran. The aim of this study was to evaluate clinical and biochemical parameters as prognostic factor in acute methanol poisoning. Methods: A retrospective study was performed on acute methanol poisoning cases admitted to the Loghman Hakim Hospital Poison Center (Tehran, Iran) over a two-year period. The demographic data, clinical presentations, paraclinical findings and patients’ outcome were extracted from medical records. Results: During this period, thirty patients with acute methanol poisoning have been enrolled in the study. All of the patients were men, with the median age of 25.5 years. Visual disturbances, respiratory manifestations, and loss of consciousness were the most common clinical manifestations on admission. The median of blood methanol level was 20 mg/dL. The median of pH, PaCO2 and HCO3 was 7.15, 22.35 mmHg and 7.2 mEq/L, respectively. Fatality rate was 30%. There was a significant difference between survivors and non-survivors with regards to coma, blood methanol level, and PaCO2 and blood glucose. Also, we did not observe a significant difference between these two groups regarding pH and HCO3 level. Conclusion: It can be suggested that coma, PaCO2 and hyperglycemia on admission time could be used as strong predictors of poor outcome and blood pH and HCO3 is not a good prognostic factor for assessment of methanol poisoning outcome.

Tricyclic antidepressant poisoning treated by magnesium sulfate: a randomized, clinical trial

Tricyclic antidepressant (TCA) poisoning is a major problem in medicine, with a high morbidity and mortality rate. The main cause of fatality is cardiac arrhythmias resulting from intoxication. Sodium bicarbonate is the drug of choice, but severe poisoning necessitates further interventions. Magnesium sulfate seems to be effective in this condition. In a randomized, clinical trial, we evaluated all patients with a history of TCA intoxication referred to the Loghman Hakim Hospital Poison Center. The patients were randomly divided into two groups: one treated by bicarbonate infusion (control group) and the other (case group) by the infusion of magnesium sulfate in addition to the treatment in the first group. Seventy-two patients were recruited into the study (36 cases and 36 controls). Mean duration of intensive care unit stay in the cases and controls were 25.63 ± 9.33 and 82.67 ± 21.66 hours, respectively (P < 0.001). Mortality rate in the case group was 13.9% and 33.3% in the other group (P = 0.052). Magnesium sulfate can be an effective drug in the treatment of TCA poisoning; however, several randomized, clinical trials are still necessary to confirm this.

Fatal aluminum phosphide poisoning in Tehran-Iran from 2007 to 20100

Aluminum phosphide (AlP) is also known as "rice tablet" in Iran. Due to the high incidence of acute AlP poisoning and its associated mortality in Iran, the authorities banned AlP-containing tablets in 2007. The aim of this study is to evaluate the trend of acute fatal AlP poisoning subsequent to this restriction. 0 This is a retrospective chart review of patients with acute "rice tablet" poisoning who were admitted to Loghman Hakim Hospital Poison Center, Tehran, Iran, from 2007 to 2010. Collected information included gender, age, type of poisoning, marital status, duration of hospitalization, and outcome. There were 956 cases with a mortality rate of 24.06%. The incidence of fatal AlP poisoning was 2.1 and 5.81 per one million populations of Tehran in 2007 and 2010, respectively. In 223 of the fatal cases (97%) and 697 of the non-fatal cases (96%), the poisoning was intentional. The male to female ratio in the fatal and non-fatal cases was 1.04:1 and 1:1.3, respectively. Most of the fatal cases (n = 122, 53%) were unmarried. The mean age was 27.32 ± 11.31 and 24.5 ± 8.19 years in fatal and non-fatal cases, respectively. In 196 (85.2%) of the fatal cases and in 577 (79%) of non-fatal cases, the duration of hospitalization was less than 24 hours and between 48-72 hours, respectively. The results of this study showed the incidence of "rice tablet" poisoning, and its mortality increased since 2007 in spite of the ban. It seems that legislative means alone without other interventions, such as suicide prevention and public education, will not always be able to control or prevent acute intentional poisonings.

P03-99 - Antidepressant self-poisonings in iran

IntroductionTricyclic antidepressants (TCAs) are more likely to cause cardiovascular and neurological toxicity than compared to Selective Serotonin Reuptake Inhibitors (SSRIs).ObjectivesIn a prospective hospital-based cohort study, we addressed the question of severity and outcome of antidepressant self-poisonings in patients who attended the Loghman-Hakim Hospital Poison Center. The severity was judged by impairment of consciousness, the outcome criteria were the requirement of inpatient treatment and endotracheal intubation as well as mortality. The aim of the study was to find out if TCA intoxications require more therapeutic efforts than SSRI intoxications.MethodsFrom 28 March to 20 May 20 2006, all patients presented to the Poison Center were documented using preformatted forms by three trained nurses blinded to any study hypotheses. From 3.578 intoxications, a number of 334 patients with antidepressant or lithium self-poisoning was identified (9.3% of all poisoning cases; 233 females, 101 males; median age 24 years, min 13, max 70).ResultsAs compared to SSRI single-substance intoxications (n = 17), TCA single-substance intoxications (n = 73) were associated with (1) a significantly lower level of consciousness (p = 0.005); (2) a significantly higher admission frequency (80.8% vs. 35.3%; p &lt; 0.001) and (3) a higher intubation frequency (13.7% vs. 0%; p = ns). SSRI multiple-substance intoxications were associated with a significantly lower level of consciousness than SSRI single-substance intoxications (p = 0.042), while there was no significant difference between TCA multiple- and single-substance intoxications.ConclusionsThis study suggests that an overdose with SSRIs results in a more favorable clinical outcome than an overdose with TCAs.

Opium addiction and lead poisoning

Background: Exposure to lead is usually considered only when a patient's history points to well-known traditional sources of lead. Although the incidence of lead poisoning has declined, the new forms of this type of poisoning still exist. Recently, unusual causes of chronic lead poisoning such as substance abuses have been described. The aim of this article is to present patients with lead poisoning and positive history of opium addiction.Patients and Method: In this study, we evaluated 25 patients seen from 2002 to 2007 with lead poisoning in the Loghman Hakim Hospital Poison Center, Tehran, Iran. Data such as age, sex, causes of intoxication, route of poisoning, clinical manifestations on admission, duration of hospitalization, blood lead level and history of addiction were extracted from the patients' files.Results: Seven of the patients had a history of opium addiction as the only probable source of lead poisoning, and none of them had occupations known to involve exposure to lead. The average age of these patients was 38.7 ± 9.3 years. The average blood lead level in these patients was 109 ± 37.6 μg/dL.Conclusion: Lead poisoning should be considered in patients with a history of opium abuse who present with non-specific clinical manifestations.

Poison treatment centers in Iran

In Iran, almost all emergency departments and most of the intensive care units (ICUs) treat poisoning patients, but there are some hospitals that serve to poisoning cases in a specific manner and are equipped with antidotes. Likely, Tehran, Mashhad, and Isfahan Universities have perfect clinical poisoning treatment centers that are mainly used for the education of medical students and residents. In Tehran, LoghmanHakim hospital poison center is an absolutely well-known and the most famous center for treatment of poisoning patients in Tehran and nearby cities. It is a teaching hospital affiliated to Shahid Beheshti University of Medical Sciences. Within this poison center, there is a perfect emergency department, unique intensive care unit (ICU) with 20 inpatient beds, and a specific poisoning ward. Also, the center has been joined by a Toxicological Research Center (TRC) that is located within the same hospital. Totally, there are 82 inpatient beds for intoxicated patients. Annually, more than 25,000 poisoned patients are referred to this center. The next famous poison center of Iran is Imam Reza hospital poison center, which is a treatment center for poisoning patients located in the city Mashhad. This center is affiliated to a teaching hospital owned by Mashhad University of Medical Sciences. This center has been joined to the Medical Toxicology Research Center (MTC), which has research labs, clinic, and ward for the poisoning patients. This center collaborates with the International Program on Chemical Safety (IPCS). The other active poisoning treatment center is the Emergency Department of Noor teaching hospital, located in Isfahan University of Medical Sciences in Isfahan. It consists of 6 ICU beds and 15 ward beds. Regularly, anesthesiology residents, interns, and other medical students are taught about management of poisoning cases in this center. The Clinical Toxicology Research Center, which is also located inside the Noor hospital, collaborates with this poison center in providing research projects to study on acute and chronic poisonings. Baharloo hospital is another teaching hospital affiliated to Tehran University of Medical Sciences, which has been newly established and has a perfect poisoning treatment center. This center has a 10-bed toxicology ICU and 15 ward beds to provide highly specialized care of various intoxications. Yaftabad hospital is another teaching hospital affiliated to Iran University of Medical Sciences located in Tehran, which has a separate emergency department for poisoned patients, equipped with 8-bed toxicology ICU. Razi hospital is another teaching hospital affiliated to Ahwaz Jundishapur University of Medical Sciences located in Ahwaz, a city in south of Iran. Razi hospital primarily focuses on toxicology of scorpion and snakes that are common in that region of the country. Shoshtari hospital is another teaching hospital affiliated to Shiraz University of Medical Sciences located in Shiraz. This hospital also has a specific 15-bed poisoning ward. Furthermore, there are other centers located in other cities including Arak, Ardabil, Birjand, Hamadan, Tabriz, Sari, Rasht, and Urmia, which have separate beds for management of poisoning cases; although they do not have special poisoning ward, they are improving. In addition, there are strong Drug and Poison Information Centers (DPICs) that work under the supervision of the Medical Universities and the Food and Drug Department of the Ministry of Health (MOH). The first official DPIC was established in 1995 at Tehran by a team supervised by Prof Mohammad

Late extensive intravenous administration of N-acetylcysteine can reverse hepatic failure in acetaminophen overdose

Acetaminophen is a commonly used analgesic and has been shown to be a main cause of drug-induced liver failure. N-acetylcysteine (NAC) should be employed as the antidote in case of acetaminophen poisoning within the first 8-10 hours. Oral administration of NAC is universally recommended and due to the adverse effects, the intravenous administration of the agent is reserved for patients with oral intolerance and severe complications. We here report an 18-year-old man with severe liver failure due to a huge ingestion of acetaminophen, who was taken into the Loghman Hakim Hospital Poison Center 72 hours after attempted suicide. Regarding the poor prognostic clues as his level of consciousness and impaired liver functions, an extensive intravenous regimen of NAC was started. The patient survived the condition with an additional intravenous administration of NAC past the first 72 hours of treatment. We discuss that even in late phases of intoxication; high-dose intravenous NAC can serve a substantial improvement.

Self-poisonings with tricyclic antidepressants and selective serotonin reuptake inhibitors in Tehran, Iran

In a prospective hospital-based cohort study, we addressed the question of severity and outcome of antidepressant poisonings in patients who attended the Loghman-Hakim Hospital Poison Center, the only national center in Tehran dedicated for detoxification. The aim of the study was to find out if tricyclic antidepressant (TCA) intoxications require more therapeutic efforts than selective serotonin reuptake inhibitor (SSRI) intoxications. The study was applied over a 7-week period (28 March–20 May 2006). From 3578 intoxications, 334 patients with antidepressant or lithium self-poisoning were identified (9.3% of all poisoning cases; 233 females, 101 males; median age 24 years, min 13, max 70). Compared to SSRI single-substance intoxications (n=17), TCA single-substance intoxications (n=73) were associated with: (1) a significantly lower level of consciousness (P=0.005); (2) a significantly higher admission frequency (80.8 vs. 35.3%; P<0.001); and (3) a higher intubation frequency (13.7 vs. 0%; P=ns). SSRI multiple-substance intoxications were associated with a significantly lower level of consciousness than SSRI single-substance intoxications (P=0.042), while there was no significant difference between TCA multiple- and single-substance intoxications. This study suggests that an overdose with SSRIs results in a more favourable clinical outcome than an overdose with TCAs.

Hyperglycemia in acute aluminum phosphide poisoning as a potential prognostic factor

Aluminum phosphide (AlP) is a solid fumigant widely used in Iran as a grain preservative. When reacted with water or acids, AIP produces phosphine gas, a mitochondrial poison that interferes with oxidative phosphorylation and protein synthesis. Poisoning by AIP is one of the most important causes of fatal chemical toxicity in Iran. There are few studies in the medical literature addressing prognostic factors associated with AlP poisoning. In this prospective study conducted across a 14-month period commencing on 21st March 2006, we enrolled all patients admitted to the ICU of Loghman-Hakim Hospital Poison Center (Tehran, Iran) with AIP poisoning, no history of diabetes mellitus diagnosed before hospitalization, and normal body mass index. We recorded patient-specific demographic information, blood glucose level on presentation (before treatment), arterial blood gas (ABG) analysis, time elapsed between ingestion and presentation, ingested dose, duration of intensive care admission, and outcome data related to each presentation. We enrolled the group of patients who survived the intoxication as a control group and compared their blood glucose levels with those who died because of AlP poisoning. Data were analyzed by Statistical Product and Service Solutions (SPSS) software (Version 12; Chicago, Ilinois, USA) using logistic regression, Pearson correlation coefficient and Student's t-test. P values of 0.05 or less were considered as the statistical significant levels. Forty-five patients (21 women and 24 men) with acute AlP poisoning were included in the study. The mean age was 27.3 +/- 11.5 years (range: 14-62 years). Thirteen patients survived (29%) and 32 expired (71%). AlP poisoning followed deliberate ingestion in all patients. The time elapsed between ingestion and arrival at the hospital was 3.2 +/- 0.4 h. There was no significant difference between survived and non-survived groups according to age, gender, and time to treatment. However, the difference between mean blood glucose levels in survived (143.4 +/- 13.7 mg/dL) and non-survived (222.6 +/- 20 mg/dL) cases was statistically significant (P = 0.021). There was no significant correlation between blood glucose level and time to treatment, age, gender, pH, HCO3 concentration, and ingested dose. Twenty-three (71.9%) of non-survived and four (30.8%) of survived patients had a blood glucose level greater than 140 mg/dL. After adjusting according to age, gender, ingested dose, pH and HCO3 concentration The odds ratio for hyperglycemia as a risk factor for death was 5.7 (CI of 1.4-23.4). In our study, patients who succumbed to AIP poisoning had significantly higher mean blood glucose levels than those who survived. This correlation of hyperglycemic effect and mortality suggests that it may be useful in guiding risk assessment and treatment of AIP poisoning. Management of hyperglycemia may have a useful role in treatment of these patients by allowing increased entrance of glucose into cells and reducing oxygen consumption.

Tramadol intoxication: a review of 114 cases

Tramadol as a centrally acting analgesic is extensively used in the management of moderate to severe pain. It slightly affects opioid receptors and inhibits the reuptake of norepinephrin and serotonin in the CNS. There are reports about toxicity and abuse of tramadol. The objective of the present study was to evaluate epidemiology of intentional tramadol intoxications. All poisoning cases that admitted to Loghman-Hakim Hospital Poison Center from April to May 2007 were studied. A total of 114 cases (82 men and 32 women) of intentional tramadol intoxications with the median age of 23.66 +/- 6.87 years (range 16-54 years) were identified. Other illicit drugs were found to be used in combination with tramadol in some of the cases, which among them benzodiazepines were the most common. Tramadol overdose has been one of the most frequent causes of drug poisoning in the country in the recent years, especially in male young adults with history of substance abuse and mental disorders. Nausea, vomiting, Central Nervous System (CNS) depression, tachycardia, and seizure are the most common findings in this kind of poisoning. Cardiopulmonary arrest was found as the cause of death in cases who had ingested more than 5000 mg tramadol.

Pattern of acute poisoning in Tehran-Iran in 2003

To characterize the poisoning cases admitted to the Loghman-Hakim Hospital Poison Center (a teaching reference hospital of poisoning) in Tehran, Iran. All admitted acutely poisoned patients from January to December 2003 were evaluated retrospectively. Information of socio-demographic characteristics, agents and cause of poisoning, and the mortality rate were collected from medical records of the hospital. During this period, 24 179 cases were referred to the emergency department that 10 206 of them were admitted. Of the admitted cases, 51% were male and 49% female. The majority (38%) of cases were in the age range of 21-30 years. Most (79%) of poisonings were intentional and 21% were unintentional. The most important agents of acute poisoning were drugs (69.13%) especially sedative-hypnotics followed by opioids (12.34%) and pesticides especially organophosphates (OPs) (6.21%). The mortality rate was 1.3% (318 patients). Death was mostly occurred by opioids (41.54%), followed by drugs (28%) and pesticides especially OPs (12%). The prevention and treatment of poisoning due to opioids, pesticides specially OPs and sedative-hypnotics drugs should merit high priority in the health care of the indigenous population of Tehran.

A simplified acute physiology score in the prediction of acute organophosphate poisoning outcome in an intensive care unit

Organophosphate poisoning (OPP) occurs frequently and accounts for a large number of intoxication cases treated in intensive care units (ICU). Poisoning by these agents is a serious public health problem. Among pesticides, OPs are the main cause of poisoning and death in Loghman-Hakim Poison Center of Tehran, Iran. The aim of this study was to determine the impact of the Simplified Acute Physiology Score (SAPS II) in the prediction of mortality in patients with acute OPP requiring admission to the ICU of Loghman-Hakim Hospital Poison Center over a period of 12 months. This study was a prospective, case-control of records of patients with acute OPP admitted to the ICU between January 2006 and December 2006. The Demographic data were collected and SAPS II score was recorded. During the study period, 24 subjects were admitted to the ICU with acute OPP. All 24 patients (15 male) required endotracheal intubation and mechanical ventilation in addition to gastric decontamination and standard therapy with atropine and oximes and adequate hydration. Of these, 24 patients, eight (five male) died. SAPS II score was significantly higher in the non-survival group than the survival group. Mortality following acute OPP remains high despite adequate intensive care and specific therapy with atropine and oximes. One-third of the subjects needing intensive care die within the hospitalization period. SAPS II scores calculated within the first 24 hours were recognized as good prognostic indicator among patients with acute OPP that required ICU admission. It is concluded that SAPS II score above 11 within the first 24 hours is a predictor of poor outcome in patients with acute OPP requiring ICU admission.

Prognostic factors in methanol poisoning

The aim of this study was to assess the clinical and laboratory factors in methanol poisoned patients to determine the prognosis of their toxicity. This survey was done as a prospective cross-sectional study in methanol-poisoned patients in Loghman-Hakim hospital poison center during 9 months from October 1999-June 2000. During this time 25 methanol-poisoned patients were admitted. The mortality rate was 12 (48%). Amongst survivors, three (23%) of the patients developed blindness due to their poisoning and the other 10 (77%) fully recovered without any complication. The mortality rate in comatose patients was nine (90%) while in non-comatose patients it was three (20%) (P<0.001). There was a significant difference in mean pH in the first arterial blood gas of patients who subsequently died (6.82+/-0.03) and survivors (7.15+/-0.06) (P<0.001, M-W). The mean time interval between poisoning and ED presentation in deceased patients were (46+/-15.7) hours, in survived with sequelae were (16.7+/-6.7) and in survived without sequelae were (10.3+/-7.2) hours (P<0.002, K-W). We found no significant difference between the survivors versus the patients who died regarding methanol. Simultaneous presence of ethanol and opium affected the outcome of the treatment for methanol intoxication favourably and unfavourably, respectively. In our study, poor prognosis was associated with pH<7, coma on admission and >24 hours delay from intake to admission.

A retrospective study of mushroom poisoning in Iran

The objective of this study was to describe the pattern of mushroom poisoning in adults admitted to the Loghman-Hakim Hospital Poison Center from 1992 to 2002. All patients > or = 12 years of age were included in the study. The frequency of mushroom poisoning with respect to age, sex, season, reason, place of residence, latent phase, clinical and laboratory findings, treatment, and outcome of patients was investigated. Of the 72421 poisoning cases admitted to Loghman-Hakim Hospital Poison Center from 1992 to 2002, only 37 were poisoned by consumption of toxic mushrooms. As some of the patients' files were incomplete, only 25 files were included in the study. Of this number, 68% were male. The patients' age ranged between 12 and 65 years, with a mean of 31 years of age. All cases were accidental and mostly from Tehran (36%) and the northern provinces (rainy woodlands) of Iran (32%). Autumn was the most common season for poisoning with a frequency of 80%. The latent phase of poisonings was between 0.5 and 12 hours. The most frequently reported symptoms were vomiting (84%), nausea (60%), abdominal pain (60%) and diarrhea (40%). Jaundice was observed in 44% of cases, with a 50% rate of hepatic encephalopathy. A total of 66% of patients were discharged and the duration range of hospitalization was 1-12 days. In conclusion, people should be more informed of the dangers posed by wild mushrooms. Training of physicians and nurses in the accurate diagnosis and management of patients poisoned with poisonous mushrooms would improve the rate of survival.