Clinical Signs and Symptoms and Laboratory Findings of Methadone Poisoning in Children

Sharif, Mohammad Reza; Nouri, Saeed

doi:10.5812/ijp.176

Cited by 17 publications

(16 citation statements)

References 29 publications

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“…The gastrointestinal symptoms were comparable to those reported for methadone poisoning in a previous Iranian study [16]; however, respiratory depression was less common in tramadol poisoning. Hypotension was reported in methadone poisoning [17], but we did not encounter any casses of hypotension in our study of tramadol-poisoned patients. The prevalence of tachycardia in our patients was similar to that in dextromethorphan-poisoned patients reported in a large study in the USA; however, the rate of hypertension in tramadol-poisoned patients in the current study was higher than that in dextromethorphan-poisoned patients [14].…”

Section: Discussionmentioning

confidence: 49%

Severe complications of tramadol overdose in Iran

Habibollahi

Garjani

Vahdati³

et al. 2019

Epidemiol Health

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OBJECTIVES: Severe complications of tramadol overdose have been reported; however, few large-scale studies have investigated this issue. Therefore, this study aimed to explore the presentation and complications of tramadol overdose in patients admitted to an intoxication referral center in northwestern Iran.METHODS: Patients with tramadol overdose admitted to Sina Teaching Hospital in Tabriz, Iran during 2013-2017 were included. For each patient, the following data were collected: demographics, previous drug or medication overdose, whether the patient was in the process of quitting drug use, ingested dose of tramadol and co-ingestants, Glasgow Coma Scale (GCS) score, clinical symptoms at the time of admission, and admission characteristics. Serotonin toxicity was diagnosed in patients who fit the Hunter criteria. Multiple logistic regression was performed to identify variables associated with the incidence of severe complications of tramadol overdose.RESULTS: In total, 512 cases of tramadol overdose were evaluated, of which 359 patients were included, with a median age of 41 years (range, 16-69) and a median tramadol dose of 1,500 mg (range, 500-4,000). The most frequent complications associated with tramadol overdose were hypertension (38.4%), tachycardia (24.8%), and seizure (14.5%). No serotonin toxicity was detected in patients. Having a GCS score <15, having taken a tramadol dose of >1,000 mg, being in the process of quitting drug use, being 30-49 years old, and male sex were significantly related to the incidence of severe complications of tramadol overdose.CONCLUSIONS: Although seizure was prevalent among Iranian patients with tramadol poisoning, serotonin toxicity and cardiogenic shock were rare findings.

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Section: Discussionmentioning

confidence: 49%

Severe complications of tramadol overdose in Iran

Habibollahi

Garjani

Vahdati³

et al. 2019

Epidemiol Health

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“…Methadone is a dangerous drug for children, as very small amounts of it can cause various disorders including: 1) central nervous system symptoms including loss of consciousness, miosis, delirium, and convulsion; 2) respiratory symptoms such as apnea; 3) skin symptoms; dermatologic signs and symptoms including hair loss; 4) cyanosis, 5) cardiovascular difficulties including bradycardia, bradyarrhythmia, hypotension, cardiac arrest, filiform pulse, peripheral circulation failure, prolonged corrected QT interval, and risk of torsades de pointes; 7) metabolic complications including respiratory and metabolic acidosis; 8) hypercapnia, hyponatremia, hypoxia, hypoxemia, and hypoglycemia; and 9) death (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Methadone Poisoning in Children: A Systematic Review and Meta-Analysis in Iran

Allameh¹,

Akrami²,

Mohammadi³

et al. 2017

J Pediatr Rev

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Context: Symptoms of methadone poisoning, as one of the most dangerous types of poisoning, are very serious in children. Objectives: The aim of this study was to describe causes and clinical symptoms of methadone poisoning in children admitted to hospitals in Iran. Data Sources: Relevant studies published in national and international journals before January 29, 2016 were identified by studying the available databases, including PubMed, Web of Sciences, Google Scholar, Scopus, SID, Iranmedex, MagIran, and Irandoc. Study Selection: After excluding duplicate, irrelevant, and low-quality articles, relevant papers were entered into the meta-analysis. The prevalence, mean, and standard deviation of methadone poisoning symptoms in children were statistically analyzed, using Stata version 11, and causes of methadone poisoning were presented in tables. Data Extraction: Studies with unknown sample sizes, abstracts without access to full text, articles with quality assessment scores below 15.5, and studies carried out on non-Iranian populations were excluded from the meta-analysis. Results: During the initial advanced search, 1594 articles were identified. After quality assessment, 12 papers were found eligible for the final systematic review and meta-analysis, based on the inclusion and exclusion criteria. The reported symptoms included drowsiness, vomiting, apnea, cyanosis, seizure, ataxia, and delirium. In the meta-analysis, prevalence of symptoms in referred patients was estimated at 44% (0.95% confidence interval, 0.288 to 0.609). The causes of poisoning in children included accidental feeding by parents, storage of drugs in inappropriate containers, parental addiction, and low educational level of parents. Conclusions: It is important to keep methadone in a suitable container away from children. Also, it is essential to focus on educating parents on health issues of their children.

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“…Despite the facts that younger family members of methadone abusers are at a higher risk for accidental or intentional intoxication and the seriousness of clinical consequences for poisoning with methadone dosage forms in children, the number of reported studies with a demographic and clinical description of poisoning with methadone in the pediatric population is limited. [51213141516] Sharif et al . in a study conducted in Iran have reported clinical complications in almost half (48.3%) of the children with acute methadone toxicity, which is in contrast to our study with a 7.6% of complication during treatment.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Treatment Outcomes for Hospital Care in Children with Acute Methadone Poisoning

Atighi

Eizadi-Mood

Mansourian

et al. 2018

Journal of Research in Pharmacy Practice

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Objective:The trend of methadone toxicity in children and adolescents seems to be increasing in Iran since it is used as a legal measure of the treatment for opioids addiction in methadone maintenance therapy clinics. In the present study, we describe the clinical and demographical characteristics of acute methadone toxicity in a cohort of pediatric poisoned patients in Isfahan, Iran and discussed the predictive factors for their treatment outcomes.Methods:In this 4-year cross-sectional study which was performed from 2013 to 2016 in a referral university hospital (Isfahan, Iran), medical records of the demographic and admission time clinical characteristics of all in-patients aged <18 years with acute methadone poisoning were abstracted and analyzed. According to the outcomes of hospital care and treatment, patients were divided as survived without medical complication and patients survived with at least one medical complication or death.Findings:A total number of 157 (79 male) children and adolescents with a mean age of 105.4 ± 6.1 months were hospitalized and included in the study. A total of 145 (92.4%) patients survived and discharged from the hospital without any medical complication. Pupil size, respiratory rate, and level of consciousness were predictive factors for the outcome of death or medical complications.Conclusion:It seems that methadone poisoning in children and adolescents is more commonly accidental in school-aged boys (6–12 years old) and it occurs mostly with the syrup dosage form, especially when one of the parents or people who live with the child has an addiction history and if the patients' house located in lower socioeconomic class area of Isfahan city (Iran).

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Clinical Signs and Symptoms and Laboratory Findings of Methadone Poisoning in Children

Cited by 17 publications

References 29 publications

Severe complications of tramadol overdose in Iran

Severe complications of tramadol overdose in Iran

Methadone Poisoning in Children: A Systematic Review and Meta-Analysis in Iran

Predictive Factors of Treatment Outcomes for Hospital Care in Children with Acute Methadone Poisoning

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