ABSTRACT
Although the incidence of poisoning is difficult to estimate accurately, the wide availability and accessibility of chemicals and their extensive use in a variety of applications including medicine, agriculture and industry, has increased the risk of poisoning. Severely ill patients from different toxic substances may need intensive care unit [ICU] admission for different causes including coma. Reed Coma Scale was found to be appropriate for classification and prediction of severely poisoned cases. The present work aimed at describing the demographic and clinical characteristics in toxic coma cases, and to identify and evaluate predictors of outcome. All toxic coma cases admitted to MPCC through a period from 1-1-2009 to 30-6-2009 were evaluated. The toxic coma cases were further studied by statistical tests [X2, and multivariate linear regression analysis]. Out of 769 poisoned cases, 60 cases [7.8%] were found comatose. Males surpassed females. Toxic coma cases were prevalent in the age group 18 -50 years [43.3%] followed by age group < 7 years [26.7%]. Rural cases performed 90% while urban cases were 10%. Single cases represented 66.7%. Correlating mode of poisoning to age and sex showed significant prevalence of suicidal in females and accidental mode in males. Grades of coma using Reed's classification correlated to type of poisoning showed prevalence of GIV in snake and insecticide poisoning and G I, II and III in food poisoning, drugs and insecticides respectively. Metabolic acidosis was significantly correlated to drug poisoning and agrochemicals [dormex], while hypoxia and respiratory acidosis were significantly associated with Co poisoning and snake bite. ECG changes showed tachycardia and atrial fibrillation in association to snake bites, drugs and insecticides. Meanwhile bradycardia was associated to dormex. Mortality rate was 20% of all toxic coma cases. Fifty percent of fatalities were in age group 18 - 50 years old while all toxic coma cases above 50 years had died. Studying predicting factors of outcome in toxic coma showed that age group 18 - 50 years was two times risky than 7-18 years. Snake bite, insecticides and dorm ex, grades III and IV coma were significant risk factors. Also accidental mode of exposure was found to be significant risk factor. Age group 18-50 years, snake bite, insecticides and dormex, coma grades I II and IV and accidental mode of poisoning were the most significant risk factors in the outcome of toxic coma. So study of characteristics of toxic coma cases together with identification of the most risk factors correlated to outcome, that will help in the prediction of outcome and elucidate the intensive measures that could be taken to improve the outcome as well as decrease the burden of the costs to the patient and the community