الفهرس 
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Abstract
According to WHO, adults range from 18-65 years. Adulthood is divided into three stages of development: early adulthood, (18 – 35years), middle adulthood, (36 to 55years) and late adulthood (56-65yaers).
Acute poisoning in adults is a public health problem worldwide in developed as well as developing countries and it is one of the most common reasons for attendance of the adults at hospital emergency departments (ED).
More than three million poisoning cases with 251,881death occur among the adults worldwide annually of which 99% of the fetal poisoning cases occur in developing countries according to WHO estimation record
The current system of data collection is inadequate to provide complete epidemiological information especially in developing countries so it is difficult to estimate the incidence of poisoning accurately (Lall et al., 2003)
This work aims to study the pattern and outcome of poisoning among the adults patients admitted to Sohag University Hospitals during the period from the October 2013 to September 2014.
The obtained data was documented and recorded in a special sheet constructed for each patient.
The sheets recorded the following data for each patient:
• Sociodemographic data.
• Clinical data.
• Investigational data.
• Therapeutic interventions.
• Fate and outcome.
After statistical analysis, the results were as follows:
During the study period, the total number of poisoned cases received by Sohag University Hospitals was 90cases.
Pre adulthood (<25 years) and young adulthood (25-35 years) constituted about 27.78% and 33.33. % respectively of whole acute adult’s population in the current study with mean age 33.70±12.80.
The male percentage was higher than female one (55.56% and 44.44% respectively). 67% of patients came from rural areas and the rest came from urban areas (33%). unemployed people were the commonest group exposed to acute poisoning (44%) as well as employed people (27%).
The maximum incidence of patients was during autumn and summer with percentage of (31.11%) and (28.89%) respectively.
In the current study accidental poisoning constitutes about 66.67% followed by suicidal poisoning was 33.33%. The main route of poisoning was ingestion 81.11% followed by inhalation 10%and finally injection (4.44%).
In the current study the most two prevalent toxins involved were Pesticides (28.89%) with organophosphorus the most commonly agents used followed by drug of abuse poisoning (15.56%).
Accidental poisoning more common in age group (45-65years), while Suicidal was more prevalent in age group (>25years) and age group (25-35) years. Both suicidal as well as accidental poisoning were caused mainly by Pesticides poisoning (28.33%), (30%) respectively of total admitted cases while CNS drugs were the main cause of suicidal (23.33%) of total 30 suicidal cases.
Most of the patients admitted to Sohag University Hospital came in the first 24 hours of poisoning with peak delay time within the first four hours (32.22%%).
The majority of cases under the study were normotensive with mean SBP 113.22 ± 19.36 and mean DBP 70.22±12.08.Regarding pulse, 13.33% of cases presented with tachycardia with mean 83.66±20.72%. Temperature was high in (41.11%) and respiratory rate was high in 3.33%.
Regarding complexions, about (8.89%) of cases were cyanotic at time of presentation, (7.78%) presented with pallor. In this study, drugs of abuse were the major toxins lead to development of cyanosis.
Regarding the Skin manifestations, Sweating was the main skin manifestation in this study.
28.89% presented with miosis and 10% with mydriasis, pinpointed pupil was almost caused by pesticides poisoning including OPC.
Coma was the most common neurological manifestation detected in (30%) of the total cases while convulsions was the least common (5.55%).
Coma was classified in this study according to Reed‘s classification, where 70%% were coma grade 0, 21.11%, coma grade I, 3.33% were grade II, 1.11% coma grade III and 4.44%% were coma grade IV Pesticide, CNS drugs and drugs of abuse were the most common causes of coma and caused al mostly all grades of coma according to Reed’s classifications.
Convulsions were almost caused by patients with acute tramadol intoxication (40%). hypotonia, hallucination and fasciculation occurred in 5.55% of cases in which the pesticide poisoning was the main cause of them in this study.
Vomiting was the most common GIT manifestation (45.55%) followed by colic (27.77%) and diarrhea (12.22%) Food poisoning, CVS drugs and insecticides were the main causes of vomiting, colic and diarrhea.
Insecticides, drugs of abuse, chemicals and gases the main causes of respiratory manifestations with 26.67% % of insecticide poisoned patients were presented with respiratory distress.
Palpitation is the only cardiovascular symptom present was detected in 9 cases with acute digoxin poisoning.
More than 90% of intoxicated patient had no general investigation and. The most common specific toxicological investigation done was Lanoxin level (8.89%).
The majority of poisoned patient require only supportive treatment.Mechanical ventilation was a common tool in ICU admitted serious cases.
Emesis (25.56%), gastric lavage (21.11%) and activated charcoal (35.56%) were the most frequent procedures undertaken for poisoning cases. A few cases received antidotes and the most frequently used antidote was atropine.
Regarding the hospital admission there was (34.44%) pt. received treatment in ER, (44.44%) admitted as in patients while (21.11%) admitted in the ICU and the majority (93.33%) of patients were discharged after their treatment and observation with complete recovery.
4.44% of case fatalities were recorded of total admitted cases to the hospitals, of them three cases recorded due to opioids toxicity. All cases of mortality were caused by unintentional poisoning.
Causes of death in the intoxicated cases may related to the commodities associated with this cases.
There was significant difference in outcome of patients regarding ICU admission and duration of hospitalization. Also there was statistical significant difference between outcomes as regards route of exposure and gender. While there was no significant difference between the outcome and pre hospital treatment.
Recommendations
1- More awareness programs are needed to be conducted among the general public to utilize the medical service.
2- Improving proper and complete record-keeping is also suggested for a better information access.
3- Adequate information and education on pesticide handling must be given to farmers working with these products in the rural area.
4- Substitution of the harmful insecticides by more safe or natural compounds and limitation of their use.
5- Proper restrictions should be taken in pharmacies from which pharmaceuticals and non-pharmaceuticals can be easily obtained.
-Obtaining drugs must be through written prescriptions and the doses and duration of treatment should be clear in order to adjust the dose obtained.
6- Toxicology screen tests are recommended at hospitals for proper identification of type and level of poisonous substances that leads to early and proper management of these cases.
7- Establishing poison control centers in different places of the country,
8- Preparing national treatment guidelines, training healthcare providers.
9- Ensuring easy availability of the antidotes.
10-Specificity in recording poisoning agents, rather than agent groups in
the hospital admissions.
11- Management of poisoned patients will be greatly improved if common causes and risk factors of poisoning in each region are properly defined.
12- With intentional poisoning the patients must undergo psychiatric consultation either during their stay in the hospital or after discharge.
So the availability of psychiatry consultation service in these large university hospitals with all the benefits is strongly recommended.
13- Further studies that compare the pattern and outcome of acute poisoning in the adults with other age groups as children and adolescents
14- Further prospective studies on indications of admission to ICU and predictors of outcome of acute poisoning among the adults to help physicians in detecting poisoned adult with poor outcomes quickly and to assess the magnitude and distribution of this emerging public health hazard.