ناصر جلالی

Various kinds of drugs have been evaluated as antidotes of acetaminophen; the most important of them is N-acetylcysteine (NAC). The optimal route, dose and duration of administration for NAC in the management of acetaminophen poisoning is controversial. Various anecdotal reports have mentioned development of adverse effects following intravenous NAC therapy that have restricted this form of usage. In Iran, it is unclear whether the use of intravenous NAC is associated with a significant incidence of adverse events. To investigate the frequency of adverse effects of intravenous NAC therapy, compare them with previous reports, and asses the safety of intravenous NAC therapy, we attempted to conduct this survey. This was a descriptive and prospective study, and was conducted at Loghman-Hakim Hospital in Tehran, Iran during a 1-year period (1380). We included all adult patients who had a history of one toxic dose (7.5 gr or more) of acetaminophen intake and presenting fewer than 12 hours after consumption. These patients were treated regardless of the serum levels of acetaminophen. Patients with concurrent intoxication, coma and hepatic encephalopathy were excluded from the study. Treatment of these patients was carried out using 20-hour therapeutic protocol. There was a structured data collection form, submitted to all patients prospectively. A logistic regression analysis (based on the stepwise variable selection method) was carried out using SPSS Software, with the adverse reactions as the dependent variable, and age, sex, history of asthma, and medical allergy as independent variables. Intravenous NAC was administrated to 206 adult cases. Adverse reactions to NAC were observed in 23.3% of patients. In none of the symptomatic poisoned individuals, we had to completely stop the IV NAC infusion. No patients developed any serious adverse effects requiring intensive care and there were no deaths. It was shown that there were no significant relationships between age, sex, asthma or medical allergy and side effects. On the basis of our findings, we concluded that not using the automatic infusion pump and also the low rate of hepatotoxicity would be expected to correspond with a high frequency of adverse effects. Despite the high frequency of adverse effects, they were transient, not life threatening, easily treated, and all patients received a complete course of intravenous NAC.Therefore, the treatment can be considered relatively safe in the management of acetaminophen poisoning.

Barbiturates as hypnotic drugs are widely used in medicine. They act as sedative or analgesic and are used to control seizure disorders. References show that the number cases of poisoning by this drug is very high. Rapid determination of Phenobarbital in blood of poisoned patients can lead to good treatment approaches. Several laboratory methods are currently available for the detection of barbiturates, but few are suitable for emergency use. In this study we evaluated the use of a modified uv-spectrophotometric method in determination of Phenobarbital levels in blood of poisoned patients. This method is based on differential spectrums of Phenobarbital in two alkaline environments. We compared analytical results obtained by this method with previous acceptable spectrophotometry method. There is good correlation (r=0.998) between these two methods. Our results indicate that the procedure time was approximately 45 minutes, sensitivity 2 mg/ml, precision 7.034%, recovery 99.1%. The clinical signs and symptoms and medical examinations of poisoned patients are also recorded. Our results indicated that Phenobarbital overdose is mainly manifested by sedation, tachycardia, neurologic disturbances, hypotension, myosis and hypoxemia. All of the patients had attempted suicide and were discharged alive from the hospital. We found good correlation (r=0.945) between increase in pulse rate and blood Phenobarbital levels. It may be of value in diagnosis of the severity of Phenobarbital overdose. We could not find any correlation between blood Phenobarbital levels and the rate of consciousness or grade of coma. In conclusion, the use of this method for an emergency determination of phenobarbital overdose in toxicology centers is recommended.