الفهرس | Only 14 pages are availabe for public view |
Abstract Adolescence comes from the Latin word “adolescere” meaning “to grow up” referring to the transitional complex period in human growth and development occurring between childhood and adulthood. According to WHO, adolescence ranges from 10-19 years. Adolescence is divided into three stages of development: early (10-13 years), middle (14-15 years) and late adolescence (16-19 years) stages. Acute poisoning is considered the second leading cause of adolescent mortality after road car accidents accounting for an estimated 45,000 deaths annually in children and adolescents under the age of 20 years with death rate about 1.8 per 100,000 populations in US. The study of adolescence intoxication has become more important nowadays, as there are 1.2 billion adolescents worldwide in 2012 making about 18 % of the world’s population. Nearly, 90 % of them live in developing countries which explain the possibility of increasing incidence of toxicity in this age group. Major changes occurring during this period from all aspects; biologically, psychologically and socially placing adolescents at increased risk of poisoning. This work aims to study the pattern and outcome of poisoning among adolescent patients admitted to the Poison Control Center (PCC), Ain Shams University Hospitals during the period from the beginning of July 2013 till the end of December 2013. The obtained data was documented and recorded in a special sheet constructed for each patient. The sheets recorded the following data for each patient: o Sociodemographic data. o Clinical data. o Investigational data. o Therapeutic interventions. o Outcome and severity. After statistical analysis, the results were as follows: During the study period, the total number of poisoned cases received by PCC was 9459, out of them 1931 cases were adolescents representing 20.4% of the total number of cases received by PCC. Middle adolescence (14-15 years) and late adolescence (16- 19 years) constitute about 85.7% of whole adolescent population in our study with mean age 16.166 ± 2.353. The female percentage was higher than male one (72.7% and 27.3% respectively). 72% of patients came from Cairo and the rest of patients were from other governorates. Students were the commonest group exposed to acute poisoning (75.7%) as well as adolescents of medium social status was most affected with 55.15%. The highest incidence of poisoning was in the summer month (August) with 20.1%.The majority of patients in the study were presented between 12:00 pm and 12:00 am while the least time of their presentations was between 6:00 am and 12:00 pm. In the current study self-poisoning constitutes about 73.74% followed by accidental poisoning 20.61 %.The main route of poisoning was ingestion 93.11 % followed by inhalation 4.56%, and finally injection 0.16%. The most two prevalent toxins involved in acute poisoning among adolescents were insecticides (13.98%) and pharmaceuticals with CNS drugs (9.63%) and cardiopulmonary medications(9.43%) were the most common types of drugs. Accidental poisoning in adolescents was mainly due to food poisoning (56.5%) while majority of adolescents committed suicide by using insecticides (18.7%). Tramadol was most common abused agent among adolescents (50.9%). Accidental poisoning is more common in early adolescence while selfpoisoning was more prevalent among middle and late adolescence representing. Regarding poisoning due to substance abuse, it represents 6.55% in late adolescence while only 2.54% in early adolescence stage. The majority of the patients arrived at PCC in the first four hours with peak delay time of 2 hours (28.92%) and the least number of patients came after 24 hours. The majority of patients were normotensives with mean SBP 113.36 ± 9.84 and mean DBP 74.51± 7.02.Regarding pulse, 9.1% presented with tachycardia with mean 83.7. Respiratory rate was high in 7.9% and temperature was high in 4.6%. Regarding complexions (1.76%) presented with pallor and only (0.62%) of cases were cyanotic at time of presentation mainly due to Tramadol and insecticides poisoning. Sweating was the most common skin manifestation in this study owing to the prevalence of OPC which was almost the only cause of sweating among patients in this study. 6.5% presented with miosis and only 1.3% with mydriasis. Pinpointed pupil was almost exclusively caused by insecticide poisoning including OPC or carbamates. Coma was the most common neurological manifestation (4.9%) while convulsions were the least common (0.47%). Coma was classified in this study according to Reeds classification, where 23.2% were coma grade 0, 30.5% coma grade I, 37.9.% were grade II, 2.1% coma grade III and 6.3% were coma grade IV. CNS drugs and tramadol were the most common causes of coma and caused all grades of coma according to Reed’s classifications.Convulsions were almost caused by patients with acute tramadol intoxication. Weakness occurred in 1.5% of cases and fasiculations in 2.64% of cases where insecticide poisoning is the sole cause of them in this study. Vomiting was the most common GIT manifestation (28.12%) followed by diarrhea (14.4%) and colic (14.1%) while hemetemesis was present in 0.1% only. Food poisoning, insecticides and cardiopulmonary medications were the main causes of vomiting, colic and diarrhea. Cough were present in 0.2%, while crepitations and rhonchi in 1.9% of cases.10.37% of insecticide poisoned patients are presented with chest crepitations and 1.11% of them are with cough. Palpitation was present in only 6 cases with acute theophylline poisoning. 18% of cases were hyperglycemic while 9.6% were hypoglycemic. Serum potassium level has mean lower than normal (3.29±0.56). Concerning blood gases, mean PH 7.36±0.1and mean HCO3 22.48 ± 4.26 were within normal range. ECG was done in 150 with 70% had normal ECG and about 23.33% had sinus tachycardia while PVCS the least ECG findings (1.33%).The most common specific toxicological investigation done was pseudocholine esterase (87.7%) while theophylline was the least performed level 0.7%. Induction of emesis was done in 28.8%, 1.1% in gastric lavage, 29.1% single dose activated charcoal. Multidose activated charcoal in 6.6 %. Intravenous fluids were required in 25.9% of patients, 0.5% required vasopressors while endotracheal intubation and mechanical ventilation were required in 1% of cases. Most of patients (78.87%) were admitted to ED and discharged after an observational period not exceeding 6 hours while 16.57% were admitted to inpatient and only 4.56% were admitted to ICU. Majority of patient were discharged with complete recovery (92.2%), 7.1% AMA, 0.4% died and 0.3 % were transferred to another department either due to presence of comorbidity or development of complications. In this study, PSS was applied to assess the severity and it was found that 65.2% were classified as grade 0, 23.6% as grade 1, 7% as grade 2, 3.8% as grade 3 and 0.4% as grade 4. There was statistically significant difference between different modes of poisoning, different toxic agents as regards PSS. Higher PSS was associated with a lower age as well as increased hospital stay duration.Patients who were properly managed before arrival to the PCC showed a higher PSS when compared to the mal-managed ones or those who did not receive any treatment before arrival. In the current study, there was highly significant increase in PSS in the ICU admitted cases followed by the inpatient ones when compared to the ED cases. Higher PSS was associated with tachycardia, hyperthermia, tachypnea and hypotension. |