Rhabdomyolysis among acute human poisoning cases.

Rhabdomyolysis is a clinical and biochemical syndrome occurring when skeletal muscle cells erupt and result in release of creatine phosphokinase (CPK), lactate dehydrogenase (LDH) and myoglobin into the interstitial space and plasma. Mechanical trauma, compression, excessive muscle activity and ischemia are frequent causes, but non-traumatic rhabdomyolysis is usually caused by a toxic reaction to drugs. In this study, 181 patients suspected of rhabdomyolysis were admitted to the poisoning center of Loghman-Hakim Hospital in Tehran during one year (September 2004 to September 2005) were studied. Patients were included on the basis of physical examination and blood analysis for CPK and LDH. Rhabdomyolysis was confirmed if CPK level has been greater than 975 U/L. Out of 181 patients, 64 were female and 117 were male with an age range between 13-78 years. One-hundred and forty-three (79%) patients had CPK greater than 975 U/L. In 6% of the cases, multiple drug poisoning were observed. Two patients (1.1%) had muscle pain, five patients (2.8%) had rigidity and five patients (2.8%) had muscle inflammation. One-hundred and nineteen patients (65.7%) were febrile. The most common cause of rhabdomyolysis was opium. Blood ALT showed an increase in 109 patients (60.9%), AST in 80 patients (44.7%), and LDH in 144 patients (79.6%). Fifty patients (28.2%) had higher blood direct bilirubin and 64 patients (36.4%) showed higher total bilirubin. Six percent of patients had been diagnosed as ARF by indication of creatinine greater than 1.4 mg/dL. Five percent of patients had hypernatremia and 1.1% of patients had hyperkalemia. It is concluded that rhabdomyolysis is a matter of concern in human poisonings and needs special approach to attend.

The prevalence of hepatitis B, hepatitis C and HIV infections in non-IV drug opioid poisoned patients in Tehran-Iran.

The present study intends to look into the prevalence of these infections in the non-IVdrug abusing addicts whom were treated at our center. A pilot study was conducted on 20 patients who were admitted in poisoning center of Loghman-Hakim Hospital in Tehran due to non-IV drug overdose. One positive HIV antibody and one positive HBS antigen cases were found in this group. The pilot study was later expanded to a descriptive cross-sectional study on 214 patients. In this study 196 patients (91.6%) were male and 18 (8.4%) were female. The average age of subjects was 37.9, having the highest frequency between 20 to 30-years-old. The study showed that 14.48% (F = 31) had positive HCV antibody and 1.86% (F = 4) had positive HBS antigen and 1.4% (F = 3) had positive HIV antibody in their blood serum. One hundred and forty three patients (66.8%), were poisoned through oral opium consumption, 24 patients (11.2%) through inhalation and 18 (8.4%) both oral and inhalation. The remain; were IV-abuser or the manner of poisoning was unknown. This study signifies the need for heightened attention and preventive measures against the infection of the health care professionals by hepatitis C (HCV) virus.