Evaluation of children presented with neurological drug intoxication

Evaluation of children presented with neurological drug intoxication Introduction and Objective: This study aims to study hospitalized children with neurological drug intoxication admitted to the Dicle University Pediatric Emergency Outpatient Clinic from the Province of Diyarbakir and the surrounding cities in Turkey between 2011 and 2015. Materials and Methods: Of the children admitted to the Dicle University, Department of Pediatrics Emergency Service with the diagnosis of neurological drug intoxication, 104 children hospitalized for follow-up in the 0-18 age group were evaluated retrospectively. Patients' age, gender, type of medication, additional drugs taken, signs and symptoms caused by the intoxication, clinical and vital signs, ECG and laboratory data, duration of hospital stay were examined. Results: In our study, 51.9% of the patients who admitted to the emergency service of the hospital was female, and 48.1% was male. Looking at the patients' residential origins, 17.3% was from rural, 82.7% was from urban areas. The average age of patients was 61,87±54,93 months. Their admission time to the hospital was in the range of 0.25 - 28 hours, and its mean time was 3.25±3.95 hours. The average hospital stay time in the intensive care was 1.79±1.57 days. Of the patients, 4.8% was under 1 year of age, 49% was in the 1-3-year age group, 17.3% was in the 3-6-year age group, 12.5% was in the 6-12-year age group, and 16.3% was 12 years of age and over. The first three drug intoxications present at the time of admission were Amitriptyline by 29.8%, Risperidone by 8.7%, and Olanzapine by 7.7% respectively. It was observed that the reasons of drug intoxication was accident by 80.8%, and suicide attempt by 19.2%. In the comparison of laboratory values before and after treatment, it was observed that there was a statistically significant difference between the serum urea values before and after treatment (22.66±7.72 mg/dL and 16.60±6.60 mg/dL respectively) (p= 0.000). A statistically significant difference was also observed between serum potassium values before and after treatment (4.08±.481 mEq/L and 4.32±.432 mEq/L respectively) (p= 0.000). And, a statistically significant difference was also observed between serum Ca values before and after treatment (9.50±.574 mEq/L and 9.68±0.484 mEq/L respectively) (p= 0.002). A statistically significant difference was also observed between serum white blood cell count before and after treatment (10,08±2,85 K/mm3 and 8,76±2,90 K/mm3 respectively) (p= 0.001). In the distribution of reasons of drug intoxication by gender, it was accident by 90%, and suicide attempt by 10% in males, whereas it was 72.2% accident and 27.8% suicide attempt in females. There was a statistically significant difference between the genders in terms of causes of drug intoxication (p<0.05). Considering the causes of drug intoxication by age groups, 6% in the 0-1 age group, 60% in the 1-3 age group, 21.4% in the 3-6 age group, and 11.9% in the 6-12 age group had accidental drug intoxication, whereas 15% in the 6-12 age group, and 85% in the 12 years and above group was due to suicide attempt. A statistically significant difference was found between the age groups in terms of the causes of drug intoxication (p <0.05). Considering the causes of drug intoxication based on number of drugs taken, 88.2% was accident, and 11.8% was suicide attempt in those who used a single drug. And, it was 60% accident, 40% suicide attempt in those who used two drugs. However, it was found in those who used three or more drugs that it was 33.6% accident, and 66.7% suicide attempt. A statistically significant difference was found between the causes of drug intoxication and number of drugs taken (p <0.05). Considering the causes of drug intoxication and activated charcoal application, it was observed that 93.3% was due to accident, and 6.7% was suicide attempt in those who had no activated charcoal applied, whereas it was 75.7% accident, and 24.3% suicide attempt in patients who had activated charcoal administered. A statistically significant difference also was found between the causes of drug intoxication and administration of activated charcoal (p <0.05). Conclusion: The follow-up and treatment of most of the intoxicated patients are performed in pediatric emergency service. Accidents and carelessness of families that cause unconscious use of drugs in children were the main cause of drug intoxication, and the intoxications due to suicide attempts were relatively few, and seen in female children mainly. In addition to measures to be taken by families, drug manufacturers, and physicians, retrospective and prospective multicenter studies to be conducted for determining the epidemiological characteristics of intoxications in Turkey will have an important contribution in the prevention of childhood intoxications as well as reducing its mortality and morbidity. Keywords: Neurological drugs, intoxication, children.