Background: Poisoning is one of the major causes of seizure in emergency medicine. Because of the varying availability of drugs in different areas and insufficient control of the sale of some dangerous industrial substances, the causes of seizure in poisoned patients may be differ in our society. In this study, we examine the causes of seizures in poisoned patients in Iran, and their outcomes.
Methods: This retrospective and analytical-descriptive study investigated the sex, age, type of poison, presence and type of seizure, seizure treatment and outcome from the records of 2,220 hospitalized poison victims from 2001 to 2003 in poison emergency departments in Noor Hospital. Data was analyzed by one-way analysis of variance and chi square tests using SPSS.
Results: Of the 2,220 patient records examined, 66 patients developed seizure. Seizure was more common in men (33 patients), and most common in the 15-40 year age group (28 patients). The most common causes of seizure were tricyclic antidepressants (TCA) (39.7%), organophosphates (17.5%), carbamazepine (7.9%) and organochlorines (6.3%). However, status epilepticus was more common in organochlorine (25%), organophosphate, TCA (18.75%), and carbamazepine (12.5%) poisoning. There was a negative relationship between age and type of seizures. Seizure was not related to previous history of seizure. Midazolam alone (25%) was the most effective drug for controlling seizures. Death occurred in six patients with or without renal complication. The mortality rate among poisoned patients with seizure was 37.5%.
Conclusion: The incidence of seizure in our study reflects the availability of certain drugs and toxins that require more steadfast control. Midazolam, with its low side effects, may be the drug of choice for the treatment of status epilepticus in poisoning.