الفهرس 
abstractOnly 14 pages are availabe for public view
 |  | from | 159 |  |  |
| | | from | 159 | | |
Abstract
Drug abuse is a world-wide problem that extends across socio-economic, cultural and religious borders. Throughout human history, drug abuse represents an international public health concern not only because these abused substances are considered one of the most dangerous hazards to health in terms of mortality, disability and poor quality of life but also because of the unusual economic load and cost they have on poor medical and societal supplies.
The total number of cases admitted to the Poison Control Centre of Ain-Shams University Hospital from the start of January 2015 till the end of December 2016 was 803 cases. The ages of the studied cases ranged from 1 month to 83 years with mean ± SD 21.6 ± 16.8 years.
The majority of cases were during early adulthood period ranged from 18-40 years (46.9 %) followed by childhood period ranged from 2-18 years (27.5 %) then late adulthood period ranged from 40-60 years (12.2 %). The predominant sex in cases were males (72.9 %) compared to (27.1 %) females and most of cases were living in urban areas (67.4 %). According to the marital status, the majority were single (66.6 %) while (29.9 %) were married and (3.5 %) were widow or divorced.
According to the mode of toxicity, the majority of cases were accidental (86.8 %) either due to drugs taken by a mistake or overdose from patients with recreational abuse. Suicidal poisoning was in (13.2 %) only. Accidental poisoning was more common than suicidal among all age categories. No suicidal cases were reported during infancy and elderly. Also, accidental poisoning was more common in males (76.8 %) while suicidal poisoning was more common in females (52.8 %).
It was found that the most prevalent addictive drug involved in poisoning was tramadol (36.5 %) followed by cannabis (22.8 %) then BZs (11.7 %). In combined toxicity, tramadol and opiates was the most common (6.4 %) followed by tramadol and BZs (2 %) then tramadol and cannabis (1.5 %). The most common route of intake was oral (85.4 %) followed by parenteral (7.8 %) then inhalation (6.2 %). However, in patients with combined toxicity inhalation was the most common for the second drug (66.2 %).
Most of the patients were vitally stable on admission. The most common abnormalities were tachycardia (13.3 %) and bradypnea (8.5 %). Regarding the clinical manifestations, the most common clinical presentation was DCL (68.6 %) followed by miosis (30.9 %) then GIT upset (10.3 %).
Regarding the effect on serum electrolytes and blood glucose level, most of the patients had normal serum sodium, potassium and blood glucose level at presentation time. However, hypokalemia was detected in (28.8 %). Regarding ABG, the most common detected abnormality on admission was respiratory acidosis in (23.5 %) of patients followed by metabolic acidosis (22.4 %) then respiratory alkalosis (2.9 %). Most of cases had normal ABG (50.8 %) and no case was reported with metabolic alkalosis.
(60 %) of patients were managed in the ICU, (3.7 %) in the observation rooms and (36.7 %) in the inpatient wards. Treatment of addictive drugs induced acute toxicity like other toxicity depend on supportive and symptomatic ttt, elimination of the poison from the body and the use of antidote if available. For airway and breathing, oxygen was used in (21.4 %), endo-tracheal tube was inserted in (20.3 %) and (16.8 %) of patients were put on mechanical ventilation. For circulation, all patients received IV fluids, steroids (7 %) and dopamine (2.6 %). For symptomatic ttt, antibiotics was used in (0.9 %), anti-emetics (0.9 %), H2 blockers (6.1 %), bicarbonate (1.9 %), sedative hypnotics (12 %), epanutin (0.1 %) and Mannitol (3 %).
GIT decontamination was not the key role in ttt as most of the patients presented with DCL. Activated charcoal was used in (3.9 %) of patients, Gastric lavage (0.7 %) and mechanical emesis in (0.1 %). Hemodialysis was used to eliminate the poison from the blood and used in (1.4 %) of patients.
Regarding the antidote, atropine and toxoguonin were used in (0.6 %) of patients who had combined toxicity with organo-phosphorus compounds. Ethanol (2 %), folic acid (1.1 %), naloxone (16.6 %) and flumazenil was used in (2.2 %) of patients.
Recovery was the most common sequalae of management (93.5 %) while only (6.5 %) died. The highest mortality was in combined toxicity (20 %) followed by alcohol (13.3 %) then combined tramadol and opiate intake (11.8 %). No mortality was reported with BZs, combined tramadol and BZs intake and combined tramadol and cannabis intake.
Conclusions
Drug abuse is considered one of the most critical problems in many countries that bother the government and the society as it affects mainly the young people within the age of productivity especially males who are more affected by drugs than females.
Drug abusers not only harm themselves but also they affect their family members. Significant toxicity was detected among children and even infants. They usually imitate their parents as well as the hand to mouth behavior among infants.
Tramadol is an increasingly alarming phenomenon. Abuse has been heavily demonstrated in the Egyptian community in the last years. The prevalence increase especially among youth and middle age population may be due to the false beliefs of treating premature ejaculation and to extend the orgasm.
Like other cases of poisoning, the main method for treating addictive drugs induced acute toxicity is supportive and symptomatic treatment. The use of physiological antidote is limited to certain conditions.