الفهرس 
Definition of AdolescenceOnly 14 pages are availabe for public view
 |  | from | 241 |  |  |
| | | from | 241 | | |
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.