Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran: a cross-sectional study.

Constipation is a common reason for children seeking medical care worldwide. Abdominal complaints and constipation are also common in lead-poisoned children. This study evaluates the prevalence of abnormal blood lead levels (BLL) among pediatric and adolescent patients and examines the association of constipation with elevated BLL. This was a prospective data collection of patients younger than 18 years old with the chief complaint of constipation seen in the Mofid Children's Hospital gastroenterology clinic and Loghman Hakim pediatric and pediatric gastroenterology clinics were eligible for enrollment in this study. Constipation was defined as infrequent or difficult defecation according to ROME IV criteria lasting 2 months or more. BLL was measured with a fresh capillary whole blood capillary sample. The LeadCare II device assays BLL using an electrochemical technique (anodic stripping voltammetry). A total of 237 patients were enrolled in the study. 122 (51.48%) were female and 115 (48.52%) were male. About one fifth of patients (49; 20.67%) had BLL ≥ 5 µg/dL. The mean BLL in the sample was 3.51 µg/dL. Abdominal pain was the most common symptom accompanying constipation (134; 56%). Multivariate analysis found endoscopic evaluation (P values 0.024, OR 3.646, 95% CI 1.189-11.178), muscle pain (P values 0.020, OR 24.74, 95% CI 1.67-365.83), and maternal education (P values 0.02, OR 4.45, 95% CI 1.27-15.57) with significant differences in groups of patients with normal and elevated BLL. Elevated BLL necessitates an assessment and plans to reduce childhood lead exposure. BLL screening in childhood constipation with refractory chronic abdominal pain may also eradicate the need for invasive procedures like endoscopic evaluation.

An interrupted time series analysis of hospital admissions due to alcohol intoxication during the COVID-19 pandemic in Tehran, Iran.

The COVID-19 outbreak affected mental health globally. One of the major concerns following the COVID-19 pandemic was increased incidence of risky behaviors including alcohol consumption. This study evaluates the trend of alcohol poisoning in Loghman-Hakim Hospital (LHH), the main referral center of poisoning in Tehran, during the 2-year period from 1 year prior to 1 year after the onset (February 23rd, 2020) of the COVID-19 epidemic in Iran. All patients admitted with alcohol intoxication from February 23rd, 2019 to February 22nd, 2021 were evaluated and patient data extracted from LHH electronic hospital records. Alcohols were categorized as toxic (methyl alcohol) and non-toxic (ethyl alcohol). Of 2483 patients admitted, 796/14,493 (5.49%) and 1687/13,883 (12.15%) had been hospitalized before and after the onset of the COVID-19 epidemic in Iran, respectively. In total, 140 patients did not survive, of whom 131 (93.6%) were confirmed to have methanol intoxication. Mortality was significantly higher during the outbreak (127 vs 13; P < 0.001; OR: 4.90; CI 95%: 2.75 to 8.73). Among the patients, 503 were younger than age 20. Trend of alcohol intoxication showed increases in children (57 vs 17) and adolescents (246 vs 183) when compared before and after the COVID-19 epidemic outbreak. A total of 955 patients were diagnosed with methanol toxicity which occurred more frequently during the COVID-19 era (877 vs 78; P < 0.001; OR: 10.00; CI 95%: 7.75 to12.82). Interrupted time series analysis (April 2016-February 2021) showed that in the first month of the COVID-19 epidemic (March 2020), there was a significant increase in the alcohol intoxication rate by 13.76% (P < 0.02, CI = [2.42-24.91]). The trend of alcohol intoxication as well as resulting mortality increased in all age groups during the COVID-19 epidemic in Iran, indicating urgent need for the prevention of high-risk alcohol use as well as improved treatment.

Fatal Outcome in Acutely Poisoned Children With Hospitalization: A 10-Year Retrospective Study From Tehran, Iran.

BACKGROUND: Acute poisoning is a significant and preventable cause of mortality among children internationally. The aims of this study were to assess the case fatality rate of children admitted to an inner-city hospital for acute poisoning and to compare the demographics and source of poisoning of fatal cases. METHODS: This was a retrospective review of patient data recorded in the Hospital Information System for Loghman Hakim Hospital, that is, the central referral hospital for poisoning in Tehran, Iran. We searched Hospital Information System for all admissions for poisoning in children (age, 0-12 years) over the 10-year period from March 2010 to March 2020, and all cases were included in the analysis. We determined the case fatality rate by dividing the number of fatal cases by the number of included cases. RESULTS: Of 8158 children admitted for poisoning, 28 cases (0.3%) died, among whom 19 (67.9%) were boys and 9 (32.1%) girls. The median age was 42 months, ranging from 2 to 144 months. Twenty-two cases (78.6%) were 0 to 5 years old. The most common cause of mortality in acute poisoning was methadone (n = 13, 46.4%), followed by raw opium (n = 5, 17.9%), aluminum phosphide, carbon monoxide, and wild mushrooms (n = 2 deaths each, 7.1%). Tramadol, colchicine, and petroleum accounted for 1 death each (3.6%). CONCLUSIONS: Mortality from unintentional poisoning disproportionately affects children younger than 5 years. Opioids (ie, methadone, opium, tramadol) accounted for two thirds of deaths in our sample. Our findings highlight the importance of educating parents that any toxic materials (licit or illicit) must be stored out of reach for children.

COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

BACKGROUND: During the first wave of COVID-19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID-19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID-19 and the previous year. For poisoning admissions during COVID-19, we also evaluated the cause by age and clinical outcomes. METHODS: This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol-poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre-COVID-19 reference period (same dates in 2019). RESULTS: Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID-19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15- to 18-year-olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15- to 18-year-olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001). CONCLUSION: The Iranian methanol poisoning outbreak during the first wave of COVID-19 was associated with significantly increased hospitalization rates among children and adolescents-including at least six pediatric in-hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.

Unintentional buprenorphine and methadone poisoning in children: a matched observational study.

OBJECTIVE: To compare accidental pediatric poisoning from methadone vs. buprenorphine in terms of clinical indicators and in-hospital morbidity. METHODS: A matched observational study conducted on children aged ≤12 years admitted to our center between March 2018 and March 2019 with acute poisoning from methadone or buprenorphine. Data were extracted from the electronic patient files of the pediatric methadone poisoning cases, and buprenorphine poisoning cases were followed from ED, during the study period. Cases were compared regarding rates of bradypnea/apnea (primary outcome), the need for antidote therapy and intubation, duration of hospital stay, miosis, loss of consciousness, blood gas analyses, and mortality (secondary outcomes). RESULTS: A total of 90 methadone- and 30 buprenorphine-poisoned children were evaluated. Methadone cases had significantly higher rates of apnea (20/90 methadone vs. 0/30 buprenorphine; OR = 17.7, 95% CI 1.1, 302.8; p = 0.047), but there was no group difference in bradypnea (39/90 methadone vs. 10/30 buprenorphine; p = ns). 28 (31%) methadone and 3 buprenorphine (10%) cases had been referred to as fully awake (p = 0.013). Methadone cases required higher median naloxone doses for initial bolus (0.4 vs. 0.02 mg; p = 0.014) and maintenance infusion (14.4 vs. 2.4 mg; p < 0.001). 20 apnea cases (all from the methadone group) had miotic pupils, and miotic pupils were seen in 44 (90%) cases with bradypnea (OR = 3.2, 95% CI 1.1, 9.3; p = 0.026). Intubation was needed in only 5 methadone cases (5.5%; p = ns). All patients survived. CONCLUSION: Compared to children poisoned with methadone, buprenorphine cases had higher rates of loss of consciousness on admission but subsequently experienced fewer complications during hospital treatment, which is likely due to the buprenorphine partial antagonist effect. Our findings suggest that methadone exposure is more toxic than buprenorphine in pediatric populations.

A study of the effectiveness of naltrexone in preventing recurrence of methadone poisoning in opioid-naive children.

BACKGROUND: The prevalence of poisoning from methadone and prescription opioids is increasing in pediatric populations. Naloxone is the main antidote for treatment. Long-acting opioid toxicity may need close observation in the intensive care unit (ICU). In our previous study, naltrexone prevented re-narcotization in methadone-poisoned adults. Here, we aim to share our experience with the use of oral naltrexone for preventing recurrence of toxicity in opioid-naïve children. METHODS: In a single-center, retrospective case series, children (age ≤12 years) admitted to a poison center in Tehran (Iran) between March 2014-March 2016 were included if they presented with methadone poisoning and received naltrexone treatment in hospital. Naltrexone (1 mg/kg) was administrated orally after initial administration of 0.1 mg/kg naloxone intravenously. Children were monitored for level of consciousness, cyanosis, respiratory rate, VBG results, and O2 saturation for ≥48 h during their hospitalization. RESULTS: Eighty patients with methadone poisoning were enrolled, with median age of three years (range: 0.2-12.0). None involved polysubstance poisoning. Following naltrexone treatment, none experienced recurrent opioid toxicity during hospitalization, and hospital records indicated no readmission within 72-h post-discharge. CONCLUSION: Oral naltrexone could be a potential substitute for continuous naloxone infusion in methadone-poisoned children and reduce the need for ICU care.

Oral clonazepam versus lorazepam in the treatment of methamphetamine-poisoned children: a pilot clinical trial.

OBJECTIVES: To evaluate the efficacy of oral clonazepam versus oral lorazepam following initial parenteral benzodiazepine administration to control methamphetamine-induced agitation in children. METHODS: In a single-center clinical trial, intravenous diazepam (0.2 mg/Kg) was initially administered to all methamphetamine-poisoned pediatric patients to control their agitation, followed by a single dose of oral clonazepam (0.05 mg/Kg; n = 15) or oral lorazepam (0.05 mg/Kg; n = 15) to prevent relapse of toxicity. RESULTS: The median age [IQR] (range) was 15 [10, 36] (6-144) months. The source of poisoning was methamphetamine exposure from oral ingestion in 23 (76.7%) and passive inhalation in 7 (23.3%) patients. The most common symptoms/signs were agitation (29; 96.7%), mydriatic pupils (26; 86.7%), and tachycardia (20; 66.6%). Two in each group (13.3%) needed re-administration of intravenous diazepam due to persistent agitation. There was no report of benzodiazepine complications in either group. CONCLUSIONS: Clonazepam and lorazepam treatment was equally effective at similar doses. However, considering the higher potency of clonazepam, it seems that lorazepam is the safer benzodiazepine for oral maintenance treatment of methamphetamine-induced agitation in children and can be used with minimal complications. TRIAL REGISTRATION: IRCT20180610040036N2, April 18th, 2020. Retrospectively registered.

Blood Lead Levels in Opium-Poisoned Children: One Cross-Sectional Study in Iran.

BACKGROUND: Lead poisoning is now more common due to accidental or intentional exposure to opium impregnated with lead. We aimed to determine the relationship between the blood lead levels (BLLs) and basic characteristics in opium-poisoned children. METHODS: In this cross-sectional study, 32 children younger than 13 years old who had been admitted to Loghman Hakim Poison Center, Tehran, Iran, due to opium poisoning, were evaluated for BLLs. Patients' demographics, symptoms, signs, and lab tests were evaluated as well as the BLLs. FINDINGS: The median and range of age in children with opium poisoning were 14 and 141 months with minimum and maximum age of 3 and 144 months, respectively, and 62.5% were boys. Their mean BLL was 9.78 ± 3.44 µg/dl and in 70% of opium-poisoned children, BLL was ≥ 5 µg/dl. There was a significant difference between mean BLLs in girls and boys (17.07 ± 6.57 µg/dl in girls and 6.61 ± 3.22 µg/dl in boys, P = 0.02). We found a significant correlation between BLL and hemoglobin (Hb) level. In very low Hb level (< 8 g/dl), the BLL was higher but with increasing Hb level, BLL increased as well; in Hb levels > 14 g/dl, BLL decreased again (P = 0.01). CONCLUSION: Although none of the children needed chelation therapy, strategies should be developed to prevent children from being exposed to opium and other materials impregnated with lead regarding its effects on all organs of children.

Vitamin D toxicity in a pediatric toxicological referral center; a cross-sectional study from Iran.

BACKGROUND: Vitamin D is an essential element for body health with its supplements generally administered to prevent vitamin D deficiency. Since these supplements are available in domestic settings, vitamin D toxicity may happen in children. METHODS: All children younger than 12 years who presented to the pediatric emergency department of Loghman Hakim Hospital, Tehran, Iran with history of ingestion of more than 1500 IU/day of vitamin D supplements were enrolled. Patients' demographic data, on-presentation signs and symptoms, laboratory findings, treatments given, and outcome were evaluated. RESULT: Fifteen patients presented during the study period. Their mean age was 46.53 ± 10.14 months and 12 (80%) were girls. All of them had unintentionally ingested vitamin D. Mean ingested dose was 406700.7 ± 227400.1 IU. In eight patients (53.3%), 25 hydroxy vitamin D level was more than 100 ng/mL. One patient experienced hypercalcemia while all of them were asymptomatic and discharged without complications. There was no significant difference between patients with and without high levels of 25 OH vitamin D regarding lab tests, toxicity course, and outcome. CONCLUSIONS: It seems that acute vitamin D toxicity is a benign condition in our pediatric population which may be due to high prevalence of vitamin D deficiency in Iran.

Factors Associated With High Blood Lead Levels in a Sample of 100 Children in Tehran.

BACKGROUND: Lead is considered a neurotoxic agent. We aimed to evaluate the blood lead level (BLL) in young population and determine probable risk factors of lead exposure in Iran. METHODS: In a cross-sectional study, a total of 100 children were entered and their BLLs were checked. RESULTS: In all, 25 and 8 patients had BLLs above 5 and 10 µg/dL, respectively. There was a significant univariate correlation between BLL and place of living, water pipe type, using dairy products, and stature in both cut-offs of 5 and 10 µg/dL. Binary regression analysis showed that pipe type was associated with high BLLs at cut-offs of 5 and 10 µg/dL, respectively. Also, there was an association between 50th percentile of stature for age and cut-off of 5 µg/dL. CONCLUSIONS: Higher BLLs may be seen in short stature pediatric population. Polyvinyl chloride (PVC) and polypropylene water pipes may even cause more release of lead and result in higher absorption of this metal in the pediatric population.

Blood lead levels in pregnant women referring to midwifery clinic in a referral center in Tehran.

BACKGROUND: Lead effects on children and pregnant women are grave, and screening tests would be logical to detect high blood lead levels (BLLs) in early stages. MATERIALS AND METHODS: Blood samples were taken from the pregnant mothers who referred to midwifery clinic with further phone interview postdelivery. RESULTS: In 100 patients evaluated, the mean age was 29 ± 5 years (median interquartile range gestational age of 33 [24, 37] weeks). There was a significant correlation between polluted residential area and median BLL (P = 0.044) and substance exposure (P = 0.02). The median BLL was significantly lower in those without a history of lead toxicity in the family (P = 0.003). The only factor that could predict the BLL levels lower than 3.2 and 5 µg/dL was living in the nonindustrial area. All pregnant women delivered full-term live babies. CONCLUSION: Positive history of lead toxicity in the family and living in polluted areas may pose a higher BLL in pregnant women.

Delay-Dependent Impairments in Memory and Motor Functions After Acute Methadone Overdose in Rats.

Methadone is used as a substitution drug for the treatment of opioid dependence and chronic pain. Despite its widespread use and availability, there is a serious concern with respect to the relative safety of methadone. The purpose of this study was to characterize how acute methadone overdose affects the cognitive and motor performance of naïve healthy rats. The methadone overdose was induced by administering an acute toxic dose of methadone (15 mg/kg; ip; the equivalent dose of 80% of LD50) to adolescent rats. Resuscitation using a ventilator pump along with a single dose of naloxone (2 mg/kg; ip) was administered following the occurrence of apnea. The animals which were successfully resuscitated divided randomly into three apnea groups that evaluated either on day 1, 5, or 10 post-resuscitation (M/N-Day 1, M/N-Day 5, and M/N-Day 10 groups) in the Y-maze and novel object memory recognition tasks as well as pole and rotarod tests. The data revealed that a single toxic dose of methadone had an adverse effect on spontaneous behavior. In addition, Recognition memory impairment was observed in the M/N-Day 1, 5, and 10 groups after methadone-induced apnea. Further, descending time in the M/N-Day 5 group increased significantly in comparison with its respective Saline control group. The overall results indicate that acute methadone-overdose-induced apnea produced delay-dependent cognitive and motor impairment. We suggest that methadone poisoning should be considered as a possible cause of delayed neurological disorders, which might be transient, in some types of memory or motor performance in naïve healthy rats.

Drug-Induced Apnea in Children Admitted to Loghman Hakim Hospital, Tehran, Iran.

OBJECTIVE: Environmental hazards, including poisons, can cause irreparable effects and even fatal for children. Poisoning in children is common and serious, but often is preventable and treatable. This study aimed to evaluate the prevalence of drugs and chemical toxicity leading to apnea. In addition, we detected type of drug that induced apnea among children. MATERIALS & METHODS: In a retrospective cross-sectional study from Apr 2012 to Apr 2013, data of all hospitalized drug-induced Apnea in children were collected through hospital records. RESULTS: The most common cause of drug toxicity was methadone opium, baclofen and heroin (74%,13%,5%,2%). The mortality rate was 3.1%; all of them due to methadone poisoning. CONCLUSION: There was a high prevalence of Methadone poisoning and apnea in children. Methadone poisoning should be considered in apnea.

Eleven years of children methadone poisoning in a referral center: A review of 453 cases.

OBJECTIVES: Methadone can be fatal due to respiratory failure even in little doses. This study aimed to evaluate the possible risk factors of death and/or intubation in methadone-poisoned children of 12 years or younger. DESIGN: Retrospective routine database study. SETTING: The only tertiary hospital for children poisoning in Tehran. PATIENTS: Four hundred fifty-three methadone-poisoned patients aged 12 or younger were studied between 2001 and 2012. MAIN OUTCOME MEASURES: In-hospital mortality and intubation/mechanical ventilation. RESULTS: Of a total of 475 children included, 22 were excluded due to coingestion of other drugs. Three (0.66 percent) expired and 12 (2.65 percent) were intubated during the course of hospital stay. Intubation (p < 0.001), fever (T axillary ≥ 37.5°C, p = 0.01), being unresponsive at presentation (p = 0.02), tachycardia (p = 0.01), acidosis (p = 0.03), leukocytosis (p = 0.02), and longer hospital stay (p = 0.01) associated with death. Mortality (p < 0.001), fever (p = 0.004), aspartate aminotransferase (AST; p = 0.006), alanine transaminase (p = 0.04), creatinine (p = 0.005), corrected QT (QTc) interval in triage electrocardiogram (p = 0.02), and longer hospital stay (p = 0.005) associated with intubation in univariate analysis. However, after running regression analysis, only fever, QTc ≥ 480 ms, tachycardia, and AST independently associated with intubation and death. Axillary T ≥ 37.45 °C with an accuracy of 91.9 (95% confidence interval [CI] 88.8-94.2) and odds ratio of 9.3 (95% CI 2.5-34.9) predicted intubation, and T ≥ 37.75 with an accuracy of 96.0 (95% CI 93.5-97.5) and odds ratio of 47.4 (95% CI 4.1-550.1) predicted death. CONCLUSION: A methadone-poisoned child presenting with tachycardia, fever, abnormal AST, or an initial prolonged QTc interval should be managed with great caution.

A case-control study on risk factors for unintentional childhood poisoning in Tehran.

BACKGROUND: Poisoning is a major public health problem and is one of the most frequent causes of emergency hospital admissions. The aim of this study was to identify the main risk factors for unintentional childhood poisoning in Tehran, Iran and to suggest possible causes and preventative measures. METHODS: In this case-control study (case, n=140; control, n=280), two controls were selected for every case. Controls were matched by age, sex, and date of hospital attendance. All children and their guardians were then interviewed by the same person using a standard questionnaire that covered the demographic, behavioral, and risk factors associated with accidental poisonings. RESULTS: The most common type of poisoning was related to narcotics (58.6%); and among the narcotics, methadone was the most prevalent poisoning agent (74.7%). Multivariate conditional logistic regression model revealed that addiction in the family (OR=14.6; 95% CI:6.2-34.6), previous poisoning (OR=7; 95% CI:2.4- 20.2), maternal occupation (OR=4; 95% CI:1.3- 12.3), and inaccessibility of poisoning products (OR=0.03; 95% CI:0.01- 0.12) were the main risk factors in unintentional childhood poisoning. CONCLUSION: Addiction in the family as a risk factor and inaccessibility of poisoning products as a protecting factor were recognized to have the highest correlation with the unintentional child poisoning. These two factors were considered as priorities in health education programs.

An Epidemiologic Study of Pediatric Poisoning; a Six-month Cross-sectional Study.

INTRODUCTION: Intentional and unintentional poisoning are among the most common reasons for referrals to emergency department (ED). Therefore, the present study was designed to evaluate epidemiologic features and effective risk factors of intentional and unintentional poisoning in children. METHODS: This prospective cross-sectional study was carried out in ED of Loghman Hakim Hospital, greatest referral poison center of Iran, Tehran during March to August 2014. Demographic data, medical history, history of psychiatric disease in child, the cause of poisoning, parents' educational level, household monthly income, location of residence, history of addiction or divorce in family, and the poisoning intentionality were gathered. Data were analyzed using SPSS 18 and appropriate statistical tests based on the purpose of study. RESULTS: 414 participants with the mean age of 4.2 ± 3.43 years were included (57.5% male). Children in the 0-4 year(s) age range had the most frequency with 281 (67.9%) cases. 29 (7%) cases were intentional (62% female, 76% in the 10-14 years old group). Methadone with 123 (29.7%) cases was the most frequent toxic agent in general and in unintentional cases. 10-14 years of age (p = 0.001), and the history of psychiatric disease in children (p <0.001), had a direct correlation with probability of intentional poisoning. While, history of addiction in the family showed an indirect correlation with this probability (p = 0.045). CONCLUSION: Based on the results of this study, most cases of poisoning in the children were unintentional methadone intoxication in boys in the 0-4 age range with a history of a psychiatric disease, and those who had a history of addiction in the family. In addition, the most powerful risk factor for the children's intentional poisoning was their history of psychiatric disease. The history of addiction in the child's family had indirect correlation with intentional intoxications.

Stimulant Toxicity in Children: A Retrospective Study on 147 Patients.

OBJECTIVE: To evaluate the signs/symptoms of different stimulant toxicities in children to determine differences among them. DESIGN: Observational, retrospective, single-center case-series. SETTING: The only referral hospital for pediatric poisoned patients in Tehran, Iran, covering 12.5 million permanent and 6.5 million temporary residents. PATIENTS: All children between 2007 and 2012 were evaluated. Their clinical findings, laboratory tests, electrocardiogram, and outcome were evaluated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 147 patients were enrolled (115, 24, three, and five with methamphetamine, methylphenidate, ecstasy, and unknown stimulant toxicities, respectively). Median (interquartile range) age of the methamphetamine- intoxicated children (16 mo [22-42 mo]) was significantly less than those with methylphenidate toxicity (66 mo [33-105 mo]). Almost 79% of the patients had ingested the stimulant, whereas 9% had passively been exposed to the methamphetamine smoke. The frequency of stimulant toxicity had significantly increased during the 5-year period of the study. Restlessness, mydriasis, stereotypic movements, and talkativeness were the most common signs and symptoms. Whereas bruxism only seen in 66.7% (95% CI, 21-94%) of ecstasy users, the prevalence of restlessness, sweating, and tremor was also more in this group of children. On the other hand, mydriasis and stereotypic movements were more common in crystal-meth patients by 76.5% (95% CI, 68-83%) and 53% (95% CI, 44-62%), respectively. A comparison between different routes of crystal-meth intoxication showed that flushing was more common in those who had passively/actively smoked/inhaled methamphetamine (odds ratio, 6.3 [95% CI, 1.5-26]). Palpitation was more seen in methylphenidate toxicity by 12.5% (95% CI, 4-31%). Restlessness was more detected in toddlers, whereas talkativeness and ataxia were more common in older children. Nineteen children (21%) had prolonged QTc according to normal values in different ages. None of them died. CONCLUSIONS: More studies are warranted to evaluate the frequency and outcome of this poisoning in children. Educational preventive programs are also recommended.

Tramadol overdose and apnea in hospitalized children, a review of 20 cases.

We aimed to determine the clinical manifestations of tramadol intoxication in children and to find its potential poor prognostic factors. In a retrospective study, from 1363 cases of admitted pediatric poisoning, all tramadol-exposed hospitalized patients younger than 12 years were included in the study. They were hospitalized between March 2010 and April 2012 to the only referral hospital for pediatric poisoned patients in Tehran, Iran. Data including age, weight, gender, ingested dose (determined by history), pupil size, seizure, apnea, treatment interventions, and laboratory results was collected using chart review of the hospitalized intoxicated children. Twenty children with a mean age of 3.7 ± 2.9 years were identified amongst children during this 26-month period of whom, 14 (70%) had a decreased level of consciousness, 3 (15%) experienced apnea, and four (20%) had nausea and vomiting. Witnessed seizure did not occur in any of these patients. All patients were referred to hospital within 10.5 h of the exposure. The mean ingested dose was 9.6 ± 5.5 mg/kg. There was no significant relation between apnea and the estimated toxic dose. Apnea was more common in children who had presented with respiratory acidosis (Relative risk = 3.8, 95% CI = 1.6, 8.7, P = 0.043). All patients survived. Patients with apnea were managed conservatively by naloxone and recovered without need for intubation. Respiratory depression might occur at doses just above the therapeutic dose. We recommend an observation time of 12 h for all asymptomatic children who have ingested any dose greater than the therapeutic one.

Accidental children poisoning with methadone: an Iranian pediatric sectional study.

OBJECTIVE: Toxic poisoning with methadone is common in children in Iran. Our study was carried out due to the changing pattern of methadone poisoning in recent years and increasing methadone toxicity. MATERIALS & METHODS: In this descriptive-sectional study, all of the methadone poisoned children younger than 12 years who were admitted to the Loghman Hakim Hospital in 2012, were assessed. Clinical symptoms and signs, para-clinical findings, and treatment were evaluated. RESULTS: In this study, 16 boys and 15 girls who had been poisoned by methadone were enrolled. The mean age of patients was 55 months. All patients had been poisoned randomly or due to parent's mistakes. The mean time of symptoms onset after methadone consumption was 1 hour and 30 Min, indicating a relatively long time after onset of symptoms. Clinical findings were drowsiness (75%), miotic pupil (68 %), vomiting (61%), rapid shallow breathing (57%) and apnea (40%). In paraclinical tests, respiratory acidosis (69%) and leukocytosis (55.2%) were seen. The most important finding was increase in distance of QT in ECG (23.8%). The mean time of treatment with naloxone infusion was 51 hours. Three percent of patients had a return of symptoms after discontinuation of methadone. In patients with apnea, a longer course of treatment was required, and this difference was significant. Also, 17% of patients with apnea had aspiration pneumonia, which was statistically significant. CONCLUSION: We suggest long time treatment with naloxone and considering the probability of return of symptoms after discontinuation of methadone.