Document Type : Review Article

Authors

1 Department of Emergency Medicine, Mashhad University of Medical sciences, Mashhad, Iran

2 Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran

3 Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical sciences, Zahedan, Iran

4 Department of Internal Medicine, Jahrom University of Medical sciences, Jahrom, Iran

5 Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran

Abstract

Objective: Acute poisoning is a major health problem and one of the most common causes of emergency visits worldwide. Since most poisoning subjects present with a decreased level of consciousness and due to unreliable disease history, recognizing the etiological cause of the poisoning represents a critical part in arranging the treatment strategy. This study aimed at examining the prevalence of etiological causes of poisoning in Iran in a systematic review and meta-analysis. Method: This systematic review and meta-analysis investigated the cross-sectional studies published from 1990 to 2020, reporting specific poisoning agents among acute poisoning cases in Iran. Persian and English articles on this subject were collected by searching the Scientific Information Database (SID), ScienceDirect, PubMed, Medlib, IranMedex, Scopus, Magiran, and Google Scholar databases. The heterogeneity of the studies was investigated using the I2 index and the probability of bias in the publication was assessed by the Begg and Mazumdar test with a significance level of 0.1. Data analysis was performed by Comprehensive Meta-analysis software version 3 (Biostat, Englewood, NJ, USA). Results: In our review, 19 studies appraising 143,251 cases of poisoning were included. The ranking of the OR of each agent was done; Opium poisoning was the most prevalent poisoning case followed by benzodiazepine, acetaminophen, antipsychotic medications, organophosphates, aluminum phosphide, amphetamine, pesticide, tricyclic antidepressant (TCA), alcohol, chemicals, carbon monoxide (CO), nonsteroidal anti-inflammatory drugs (NSAIDs), and selective serotonin reuptake inhibitors (SSRIs). Conclusion: While proper judgment on the cause of poisoning and selection of suitable treatment manners could be followed by a very good prognosis in patients with acute poisoning; this demands an epidemiological perception of the prevalence of the etiological poisoning agents. Our study ranked the most likely agents leading to the poisoning, to be at the top of the list of differential diagnoses of physicians.

Keywords

Main Subjects

1. Jones LO. Poisoning. Anaesthesia & Intensive Care Medicine. 2006; 7(4): 132-4.

2. Assar S, Hatami S, Lak E, Pipelzadeh M, Joorabian M. Acute poisoning in children. Pak J Med Sci 2009; 25(1): 51-4.

3. Krenzelok EP, Dunmire SM. Acute poisoning emergencies. Resolving the gastric decontamination controversy. Postgrad Med 1992; 91(2): 179-82, 85-6. doi: 10.1080/00325481.1992.11701204.

4. Mehrpour O, Akbari A, Jahani F, Amirabadizadeh A, Allahyari E, Mansouri B, et al. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med 2018; 18(1): 30. doi: 10.1186/s12873-018-0181- 6.

5. Yardley R, Chandrashekaraiah S. Non-traumatic brain injuries. In: Arora N, Laha SK, eds. The Beginner’s Guide to Intensive Care. CRC Press; 2018.

6. Chrysanthopoulou E, Karampela I, Patsilinakou S, Konstantopoulou G, Franzeskaki F, Kontogiorgi M, et al. Admission to intensive care unit due to non-traumatic coma: etiology and outcome. Eur Respir J 2019; 54(Suppl 63): PA2282. doi: 10.1183/13993003.congress-2019. PA2282.

7. Stanca S, Ulmeanu CE, Stanca HT, Iovanescu G. Clinical features in toxic coma in children. Exp Ther Med 2019; 18(6): 5082-7. doi: 10.3892/etm.2019.7857.

8. McCoy M, Stephens-Stidham S, Barnard J, Williams B. Unintentional Drug Poisoning Deaths in Dallas County from 1997 to 2017. In: APHA’s 2019 Annual Meeting and Expo; November 2-6, 2019; Philadelphia, USA.

9. Kim M, Shin SD, Jeong S, Kwak YH, Suh GJ. Poisoninginduced Out-of-Hospital Cardiac Arrest and Outcomes according to Poison Agent. J Korean Med Sci 2017; 32(12): 2042-50. doi: 10.3346/jkms.2017.32.12.2042.

10. Alzahrani SH, Alqahtani AH, Farahat FM, Elnour MAG, Bashawri J. Drug poisoning and associated factors in western Saudi Arabia: a five-year retrospective chart review (2011-2016). Pak J Med Sci 2017; 33(5): 1188-93. doi: 10.12669/pjms.335.13119.

11. Singh O, Nasa P, Juneja D. General poisoning management. In: Chawla R, Todi S, eds. ICU Protocols. Singapore: Springer; 2020. p. 151-8. doi: 10.1007/978-981-15-0902- 5_14.

12. Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poisonings in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol 2004; 42(7): 965-75. doi: 10.1081/clt-200042550.

13. Hassanian-Moghaddam H, Pajoumand A, Sarjami S. One year epidemiological study of acute adult and adolescent poisoning admitted to Loghman hospital, Tehran. 2004- 2005. Scientific Journal of Forensic Medicine 2008; 13(4): 235-40. [In Persian].

14. Sheikhazadi A, Saberi Anary SH, Ghadyani MH. Nonfire carbon monoxide-related deaths: a survey in Tehran, Iran(2002-2006). Am J Forensic Med Pathol 2010; 31(4): 359- 63. doi: 10.1097/PAF.0b013e3181f23e02.

15. Dianat I, Nazari J. Characteristics of unintentional carbon monoxide poisoning in Northwest Iran--Tabriz. Int J Inj Contr Saf Promot 2011; 18(4): 313-20. doi: 10.1080/17457300.2011.589006.

16. Islambulchilar M, Islambulchilar Z, Kargar-Maher MH. Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. Hum Exp Toxicol 2009; 28(4): 185- 90. doi: 10.1177/0960327108099679.

17. Sobhani AR, Shojaii-Tehrani H, Nikpour E, Noroozi-Rad N. Drug and chemical poisoning in northern Iran. Arch Iran Med. 2000;3(2):1-4.

18. Soltaninejad K. Outbreak of mushroom poisoning in Iran: April-May, 2018. Int J Occup Environ Med 2018; 9(3): 152- 6. doi: 10.15171/ijoem.2018.1380.

19. Shokrzadeh M, Hajimohammadi A, Hoseinpoor R, Delaram A, Shayeste Y. An epidemiological survey of drug poisoning and a comparison with other poisonings cases admitted to a university hospital in Gorgan, Iran, 2008- 2015. Int J Epidemiol Res 2017; 4(2): 94-103.

20. Feiz Disfani H, Kamandi M, Mousavi SM, Sadrzadeh SM, Farzaneh R, Doolabi N, et al. Risk factors contributing to the incidence and mortality of acute childhood poisoning in emergency department patients in Iran: a hospital-based casecontrol study. Epidemiol Health 2019; 41: e2019016. doi: 10.4178/epih.e2019016.

21. Jafarzadeh S, Khiyali Z, Safdar S, Mobasheri F, Maleki Z. Characteristics of hospitalized patients due to intentional and unintentional poisoning in Fasa city, 2014-2016. Iranian Journal of Emergency Care 2017; 1(2): 9-18. [Persian].

22. Eslami M, Kousha S, Fesharaki M, Kazemi N, Ghafarzad A, Zamani M, et al. Evaluation prevalence and causes of drug and chemical poisoning in patients referred to emergency wards of Sina hospital of Tabriz University of Medical Sciences at 2012-13. Int J Curr Res Acad Rev 2014; 2(7): 187-94.

23. Masoumi G, Ganjei Z, Teymoori E, Sabzghabaee AM, Yaraghi A, Akabri M, et al. Evaluating the prevalence of intentional and unintentional poisoning in vulnerable patients admitted to a referral hospital. Journal of Isfahan Medical School 2013; 31(252): 1452-60. [In Persian].

24. Afzali S, Mani Kashani K, Abbasi Kolsoum F. Pattern of mortality due to poisoning by drugs and chemical agents in Hamadan, Iran, 2005-2007. Qom University of Medical Sciences Journal. 2008; 2(2): 27-32. [In Persian].

25. Ahmadi H, Hosseini J, Rezaei M. Epidemiology of tramadol overdose in Imam Khomeini hospital, Kermanshah, Iran (2008). Journal of Kermanshah University of Medical Sciences 2011; 15(1): 72-7. [In Persian].

26. Hashemnejad M, Fatehi R. Epidemiological study of poisoning in patients of Karaj Shariati hospital in 2011 to 2012. Int J Med Toxicol Forensic Med 2014; 4(1): 17-22.

27. Torkashvand F, Sheikh Fathollahi M, Shamsi S, Kamali M, Rezaeian M. Evaluating the pattern of acute poisoning in cases referred to the emergency department of Ali-ebn Abi Taleb hospital of Rafsanjan from October 2013 to September 2014. Journal of Rafsanjan University of Medical Sciences 2015; 14(4): 311-24. [In Persian].

28. Sadeghieh Ahari S, Farzaneh E, Amani F, Azari SH. Epidemiology of poisoning due to agricultural pesticides in patients referred to Ardabil city hospitals, 2012. Journal of Health and Hygiene 2014; 5(3): 240-7. [In Persian].

29. Najari F, Dadpour B, Baradaran Kayal I, Khalilzadeh M. Evaluation of the patterns of mortality due to acute poisoning in Imam Reza hospital, Mashhad, Iran, 2016. J Toxicol Cur Res 2017; 1: 001. doi: 10.24966/tcr-3735/100001.

30. Dehghani R, Fathi B, Aboo-Saaidi Z, Jalalati A, Ramezani M, Nohi M. Epidemiology of poisonings in Shahid Beheshti hospital in Kashan, Iran. Int J Med Toxicol Forensic Med 2015; 5(3): 144-50. doi: 10.22037/ijmtfm. v5i3(Summer).7578.

31. Azekour K, Belamalem S, Soulaymani A, El Houate B, El Bouhali B. Epidemiological profile of drug overdose reported in South-East Morocco from 2004 to 2016. Drugs Real World Outcomes 2019; 6(1): 11-7. doi: 10.1007/ s40801-019-0148-2.

32. Haghgou H. Suicide in Tehran, 1969-1974. Tehran: Tehran University, Faculty of Social Silences, institute for Social studies: 1997 . [In Persian].

33. Iwersen-Bergmann S, Andresen-Streichert H. [Poisoning by addictive substances, laboratory tests, and forensic medical death clarification in the case of poisoning]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62(11): 1362-9. doi: 10.1007/ s00103-019-03027-4.

34. Nourjah P, Ahmad SR, Karwoski C, Willy M. Estimates of acetaminophen (Paracetomal)-associated overdoses in the United States. Pharmacoepidemiol Drug Saf 2006; 15(6): 398-405. doi: 10.1002/pds.1191.

35. Isacsson G, Rich CL, Jureidini J, Raven M. The increased use of antidepressants has contributed to the worldwide reduction in suicide rates. Br J Psychiatry 2010; 196(6): 429- 33. doi: 10.1192/bjp.bp.109.076166.

36. Korkeila J, Salminen JK, Hiekkanen H, Salokangas RK. Use of antidepressants and suicide rate in Finland: an ecological study. J Clin Psychiatry 2007; 68(4): 505-11. doi: 10.4088/ jcp.v68n0403.

37. Zahl PH, De Leo D, Ekeberg Ø, Hjelmeland H, Dieserud G. The relationship between sales of SSRI, TCA and suicide rates in the Nordic countries. BMC Psychiatry 2010; 10: 62. doi: 10.1186/1471-244x-10-62.

38. Yaraghi A, Eizadi-Mood N, Gheshlaghi F, Montazeri K, Memarzadeh MA, Massoumi GR, et al. Evaluation of the therapeutic interventions performed in patients before and during referral to poisoning emergency department in Isfahan province. Scientific Journal of Forensic Medicine 2014; 19(1-4): 343-9. [In Persian].