Extended Abstract
Introduction
Poisoning is an event in which toxic substances enter the human body through the respiratory tract, skin, mucous membranes, or gastrointestinal tract within a short period of time, causing damage to the body and disrupting the function of multiple organs. Acute poisoning refers to accidental, intentional or unintentional exposure to a toxic substance over a short period of time, which can be fatal. Given the widespread presence of various medications, sp0orts supplements, and chemicals in homes, and the easy accessibility of these substances to young children, accidental ingestion by children under the age of 5 is common due to their curious nature. Poisoning in developing countries, due to the lack of regulatory systems, inadequate regulations, and easy accessibility of many drugs, has created a situation culminating in high rates of poisoning and emergency hospitalizations. Poisoning patterns may vary according to age and gender. Drug and chemical poisoning have been identified as two common causes of poisoning, with drug-related poisoning being the most frequent. Drug poisoning is the most common cause of hospitalization in Iranian hospitals and is estimated to be the second leading cause of death. In the agricultural regions of northern Iran, pesticide-induced poisoning is the most common cause of hospitalization. Drugs that commonly cause drug poisoning include amphetamines, opioids, methadone, heroin, and hallucinogens, such as lysergic acid diethylamide (LSD), antidepressants, and dextromethorphan.
Analysis of poisoning patterns within a specific region plays a pivotal role in identifying risk factors. Numerous studies are conducted annually in various countries to assess poisoning patterns and associated variables, such as the type of toxic substance, the cause of poisoning, and its consequences. However, there is a paucity of reports detailing the poisoning pattern in Aq Qala County, Golestan Province. Consequently, the current study aimed to determine the prevalence of narcotics-induced poisoning among children under 18 years of age referring to the Al-e-Jalil Educational and Therapeutic Center in Aq Qala County, Golestan Province.
Methods
This retrospective descriptive study was conducted on 36 children aged 1 month to 18 years (22 boys and 14 girls) referring to the Al-e-Jalil Educational and Therapeutic Center in Aq Qala due to narcotics-induced poisoning from 2020 to 2022.
The required data were collected using a data registration form and from poisoning medical records by referring to the records unit of the Aq Qala Educational and Therapeutic Center. The data were searched in the hospital information system (HIS) using code T 40.0 and subgroup X42.9, which are related to narcotics-induced poisoning (poisoning with narcotics such as opium [methadone and buprenorphine]). A total of 39 patients were found in the specified time period. Subsequently, their records were reviewed in terms of age, gender, cause of poisoning, route of exposure, type of poison, season, place of poisoning, time interval between poison ingestion and hospitalization, past medical history, duration of treatment, and poisoning outcome to categorize accidental or suicidal poisonings. The distinction between suicidal and accidental ingestion was made based on the patients’ history upon admission. Finally, 36 files were included in the study.
Results
The most frequent cause of poisoning was determined to be opium use in 25 patients (69.4%), followed by methadone in 9 patients (25%). Poisoning from B2 and tramadol was identified in one patient each (2.8%). A decreased level of consciousness upon hospital presentation was determined in 66.7% of patients (n=24). Five patients presented with apnea, 4 with agitation, and 3 were asymptomatic. Among the poisoned cases, oral ingestion was the most common route of exposure (n=35, 97.2%). Accidental poisoning was determined in 29 individuals (80.6%). Most children were male (61.1%), Turkmen (69.4%), and rural residents (86.1%). The highest cases of poisoning occurred in the summer (n=13, 36.1%). Poisoning incidents in the spring, autumn, and winter seasons comprised 19.4% (n=7), 11.1% (n=4), and 33.3% (n=12), respectively. The time interval between poisoning and hospital presentation was 5.60±3.86 hours. The mean length of hospital stay was 1.25±0.80 days, and no patients died. Intensive care unit (ICU) admission occurred in 3 patients (8.3%; 2 boys and 1 girl), each due to the use of methadone, opium, and tramadol, respectively. Sixteen patients (44.4%) made a full recovery and were discharged, while 17 patients were discharged at their own consent.
Conclusion
According to the results, poisoning cases were more prevalent among boys, a pattern consistent with numerous global studies demonstrating a higher incidence of toxic exposures in males compared to females.
Ethical Statement
This study was approved by the Ethics Committee of Golestan University of Medical Sciences (IR.GOUMS.REC.1402.247).
Funding
This article has been extracted from the doctoral dissertation of Mr. Mohsen Yekrang for a specialty degree in General Medicine at the Faculty of Medicine, Golestan University of Medical Sciences.
Conflicts of Interest
No conflict of interest.
Key message: The level of opium-induced poisoning is higher compared to other narcotics.