A Study of the Toxic Causes of Cardiac Arrest in Overdosed Patients Ghanem A.A., Attia A.M.*, Shabka O.A. Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Egypt *Corressponding Author: dr_afafattia@hotmail.com
Present Address: Professor of Clinical Pathology Mansoura Faculty of Medicine-Egypt
Online published on 20 July, 2012. Abstract Toxic cardiac arrest is an uncommon manifestation of overdose. The present study aimed to evaluate the toxic causes of cardiac arrest in patients presented to the Toxicology Unit in Mansoura Emergency Hospital – Egypt in the period from March 2008 to March 2010. At the end of the study period, forty five cases presented with cardiac arrest. 91.1% were men (41 cases) and 8.9% were women (4 cases), most of the cases were in age group 20-29 (53.3%). From all patients history and clinical examination were done, 20 ml urine and 5 ml blood samples were collected. Samples were screened by Enzyme Multiplied Immunoassay Technique (EMIT) and the positive results were confirmed by Thin Layer Chromatography (TLC). Tramadol was screened in all urine samples by TLC. The study revealed that the percentages of positive results using EMIT for opiates, cannabinoids, benzodiazepines, barbiturates, ethyl alcohol, tricyclic antidepressants (TCA) and digoxin were (15.6%, 11.1%, 68.9%, 8.9%, 6.7%, 11.1% and 8.9%) respectively. The mean digoxin level was 6.5 ±1.29 ng/ml. Six cases were diagnosed by the history and clinical examination as organophosphorus poisoning and confirmed by doing pseudo-choline esterase level with a mean level of 497.75±149.8 IU. Confirmatory testing of positive results by TLC as regards cannabinoids, benzodiazepines, barbiturates and opiates (morphine, codeine and 6 mono-acetyl morphine) were (11.1%), (28.8%), (11.1%) and (15.5%) respectively. Tramadol and tramadol co-ingestions positive results (7 and 12 cases respectively) represented about 42.2% of all cases. The commonest tramadol coingested substance was benzodiazepines (7 cases). In conclusion, the previously declared results revealed that the most common toxic cause of cardiac arrest is tramadol; as drug of abuse; whether used single or co-ingested especially with benzodiazepines. Finally, we recommend increase the scope of drug screen and confirmation methods to cover a big numbers of drugs. Top Keywords Cardiac Arrest, Acute Overdose, Tramadol, Tramadol Co-ingestions. Top |