Hypo and hyperglycemia among tramadol overdose patients in Loghman Hakim Hospital, Tehran, Iran

Tramadol is a synthetic and centrally active analgesic. Hypoglycemia as another possible major side effect among abusers has not been known well. Our objective is evaluation of the Blood Glucose Level [BGL] among tramadol-overdosed patients. This prospective cross-sectional study was performed from Feb to June 2013; BGL was measured at the time of admission, 8 and 12 hours later. All patients with hypoglycemia received infusion of 0.5-1gr/kg of hypertonic dextrose and their BGL was checked every hour until normal BGL. Patients' demographic, clinical and paraclinical data were collected. Totally, 128 patients with a mean [SD] age of 24.5 [6.9] years were recruited; 127 [99.2%] were male. Seizure occurred in 59.4% cases. Mean +/- SD admission BGL was 94.88 +/- 21.5mg/dL. Fourteen patients experienced hypoglycemia within 12 hours period. Hyperglycemia was experienced in 8 patients [6.25%] on admission day. There was no significant relation between the dose of tramadol and BGL. In conclusion, hypoglycemia must be considered asan important side effect of tramadol-overdose. It is suggested that serial BGL monitoring in cases of Tramadol-overdose should be done for early recognition of hypoglycemia and its timely management. Also hyperglycemia may be revealed

Does organophosphate poisoning cause cardiac injury?

Organophosphates are insecticides which are widely used as a suicidal agent in Iran. They are associated with different types of cardiac complications including cardiac arrest and arrhythmia, however their role in cardiac injury is not known yet. The aim of this study was to investigate the presence of myocardial damage in patients with cholinesterase poisoning. It was a prospective study conducted from January 2008 to March 2010. Cohorts of patients with cholinesterase poisoning due to suicidal attempt who have been referred to Loghman hospital were selected. Patients who have taken more than one poison or were used concomitant drugs were excluded. Physical examination was performed on admission to discover warning sign. Peripheral arterial blood gases, creatine kinase, creatine kinase-myocardial band, troponin-T measurements were performed in all cases. There were 24 patients, 7 of them women, with the mean age of 41.2 +/- 15.05 who were included in this study. Non-survivors had significantly higher levels of systolic blood pressure, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide, bicarbonate Glasgow Coma Scale scoring and longer duration of mechanical ventilation. Our findings showed that cardiac injury is an important cause of death in organophosphate poisoning. It could be hypothesized that cardiac injury is a strong predictor of death in patients with organophosphate poisoning

Severe hypoglycemia following acute aluminum phosphide [rice tablet] poisoning; a case report and review of the literature

Aluminum phosphide [AlP] as 3 g tablet is widely used in Iran to protect stored food grains from pests. Hyperglycemia following its ingestion has been already reported in the recent years but severe hypoglycemia is uncommon. Here, we report a 19 year old male who attempted suicide with one tablet of AlP and demonstrated severe hypoglycemia. Despite restoration of blood glucose concentration to normal, he failed to respond to supportive treatment and died. The possible mechanisms leading to severe hypoglycemia are discussed. Though severe hypoglycemia is rare following AlP poisoning, physicians managing such patients should be aware of it.

fatal case of Metformin intoxication

Metformin is an oral antidiabetic drug in the biguanide class. It is the first-line drug of choice for the treatment of type 2 diabetes. The most common symptoms following overdose appear to include vomiting, diarrhea, abdominal pain, tachycardia, drowsiness, and, rarely, hypoglycemia. The major potentially life-threatening complication of Metformin overdose is metabolic acidosis. We report a case of fatal Metformin toxicity following an acute intentional Metformin intoxication. Our patient 21-year-old girl who was asymptomatic when she came to Emergency department developed severe metabolic acidosis, cardiovascular compromise, hypoglycemia, and death following an acute intentional Metformin intoxication. Dysrhythmia developed later due to refractory metabolic acidosis. Severe metformin overdose could be lethal despite the patient being asymptomatic at the time of arrival. Thus the patient with severe metformin toxicity could be asymptomatic for a few hours and in the lack of any symptoms or signs of overdose he or she must be treated with early intensive sodium bicarbonate [alkalization] and hemodialysis