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Background: Chronic lead poisoning manifestations is often non-specific and may mimic neurologic diseases, gastrointestinal problems, and hematologic disorders. When there is no history of lead exposure, it may be misdiagnosed. Trying to search occult exposure is very important and poisoning could be diagnosed by a simple test of blood lead level. Methods: Here we describe a case of lead poisoning with presentation of acute generalized muscle weakness who was admitted with primary diagnosis of Botulism. We also reviewed the literatures on this topic. Results: The primary diagnosis was food poisoning in further investigation, it revealed that his job is recovering of electronic piece of old computers for about 20 years. Based on recurrent uncontrollable abdominal pain, constipation, generalized weakness, associated with hypochromic microcytic anemia, a highly suspicious to chronic lead toxicity was considered. Patient's blood lead level was 149 μgr/dL (normal:2-25). Conclusions: Detailed clinical investigation is the first step for identifying rare presentations of lead poisoning cases. The health hazards of lead poisoning are rising due to lack of education regarding the dangers of working with lead. With improving national health policies, we can prevent this chronic and subtle poisoning. [ABSTRACT FROM AUTHOR]

Aim: The effects of parenteral chelating drug for treatment of lead poisoning in reduction of blood lead levels are a challengeable subject in comparison to oral forms. The purpose of this study is to gain deeper insights into the efficacy of parenteral chelating therapy in reduction of patients' blood lead level. Method: In a cross-sectional study, 52 hospitalized symptomatic lead intoxicated patients were included. The clinical improvement and blood lead level before and after a short-course (3 days) intravenous chelator therapy was evaluated. Finally, the efficacy of mono and dual chelator therapy was compared. Results: 32 of 52 cases (61.5%) had acute lead toxicity and were symptomatic few weeks to a few months after starting use of opium and 20 cases (%38.5) were chronic user of opium (addicted) and had chronic toxicity. The mean daily dose of oral opium was 3.2 gm (min:1, max:7, SD: 1.7) and the mean duration of opium use was 10 years (min: 6 month, max: 40 yrs, SD:9.1). The mean level of lead in blood before and after a short course parenteral chelating therapy was 114.7 and 56.4 mcg/dl, respectively. Conclusion: This study showed that a single short term (3 days) parentral chelator therapy has a high efficiency on lowering the blood lead level and clinical improvement. The mean BLL will be diminished at mean of 49 percent after therapy (P value 0.001). [ABSTRACT FROM AUTHOR]

Background: Carbon monoxide (CO) poisoning results in hundreds of deaths and thousands of emergency department visits all over Iran annually. In this study, we aim to provide an epidemiologic analysis of this poisoning in different consciousness levels. Methods: This single-center retrospective study was conducted at a referral poison center from March 21, 2007 to March 19, 2012 in Tehran, Iran. All CO poisoned children and adults who hospitalized were evaluated based on their on-arrival consciousness level. Results: Two-hundred-sixty patients with pure CO poisoning were enrolled with the majority of males (55.4%). CO exposure was unintentional in 99.6% of cases. The average period between CO exposure and the patients' hospital admission was 6.4 hours (SD = 11.2). Most of the toxicities had occurred at home (73.5%). On arrival acid-base status revealed respiratory acidosis cases in 11.9% of cases. Central nervous system imaging revealed 6.2% abnormal finding. Typically, patients presented with vomiting (25.8%), nausea (22.7%), and dizziness (11.3%). Twenty-nine patients (11.2%) needed intubation and mechanical ventilation. Thirty-six patients admitted to ICU with a median [IQR] hospital stay of 6 [2, 18] days. Ultimately, 202 (78.6%) patients discharged and 47 (18.3%) left the hospital against medical advice, 5 (1.9%) died, and 10 (3.8%) experienced sequellae. Two patients (0.8%), were transferred to other hospitals for specialized care. Conclusions: The incidence and mortality rate of CO poisoning in the current study are still higher than many other parts of the world. Ongoing health prevention strategies are not efficiently working. Hence, constant public education and warning about CO toxicity should be highlighted. [ABSTRACT FROM AUTHOR]

Tramadol is a synthetic and centrally active analgesic. Hypoglycemia as another possible major side effect among abusers has not been known well. Our objective is evaluation of the Blood Glucose Level (BGL) among tramadol-overdosed patients. This prospective cross-sectional study was performed from Feb to June 2013; BGL was measured at the time of admission, 8 and 12 hours later. All patients with hypoglycemia received infusion of 0.5-1gr/kg of hypertonic dextrose and their BGL was checked every hour until normal BGL. Patients' demographic, clinical and paraclinical data were collected. Totally, 128 patients with a mean (SD) age of 24.5 (6.9) years were recruited; 127 (99.2%) were male. Seizure occurred in 59.4% cases. Mean ±SD admission BGL was 94.88±21.5mg/dL. Fourteen patients experienced hypoglycemia within 12 hours period. Hyperglycemia was experienced in 8 patients (6.25%) on admission day. There was no significant relation between the dose of tramadol and BGL. In conclusion, hypoglycemia must be considered asan important side effect of tramadol-overdose. It is suggested that serial BGL monitoring in cases of Tramadol-overdose should be done for early recognition of hypoglycemia and its timely management. Also hyperglycemia may be revealed. [ABSTRACT FROM AUTHOR]

Background: Snakebite is one of the most common health problems in endemic regions such as Iran. Due to the potential lifethreatening impact of snake envenomation and biodiversity of snakes, it seems that epidemiological studies are required, as the primary step to design standard and local therapeutic protocols, regarding the national and regional facilities and therapeutic needs. Methods: This investigation was conducted with a retrospective design, by studying all the records of patients affected by snakebite and hospitalized in Sina Hospital during 2006 to 2011. Epidemiological data and also the outcomes of patients (including side effects and survivals) were collected. The data were analyzed by SPSS software version 18, using descriptive statistics and Chi-Square test. p<0.05 was considered as significant. Results: A total of 287 snakebite patients were studied. 73.5% of patients were men and most of them belonged to the age group of 15-34 years. Most common complaints of patients once admitted were pain (74.6%) and edema (43.9%). 96.5% of the patients received 5-10 vials of anti-venom. The most prevalent side effect observed was coagulopathy (70.7%). A significant relationship was found between the anti-venom onset after the bite and the rate of coagulopathy occurrence (p=0.035). Three deaths had occurred in general. Conclusion: Early referral to medical centers and administration of anti-venom has been accompanied by significant improvement in outcomes, and would reduce the hematological side effects, need for administrating blood products, and probably the need for administration higher anti-venom doses. [ABSTRACT FROM AUTHOR]

Organophosphates are insecticides which are widely used as a suicidal agent in Iran. They are associated with different types of cardiac complications including cardiac arrest and arrhythmia, however their role in cardiac injury is not known yet. The aim of this study was to investigate the presence of myocardial damage in patients with cholinesterase poisoning. It was a prospective study conducted from January 2008 to March 2010. Cohorts of patients with cholinesterase poisoning due to suicidal attempt who have been referred to Loghman hospital were selected. Patients who have taken more than one poison or were used concomitant drugs were excluded. Physical examination was performed on admission to discover warning sign. Peripheral arterial blood gases, creatine kinase, creatine kinase-myocardial band, troponin-T measurements were performed in all cases. There were 24 patients, 7 of them women, with the mean age of 41.2±15.05 who were included in this study. Non-survivors had significantly higher levels of systolic blood pressure, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide, bicarbonate Glasgow Coma Scale scoring and longer duration of mechanical ventilation. Our findings showed that cardiac injury is an important cause of death in organophosphate poisoning. It could be hypothesized that cardiac injury is a strong predictor of death in patients with organophosphate poisoning. [ABSTRACT FROM AUTHOR]

Aluminum phosphide (AlP) as 3 g tablet is widely used in Iran to protect stored food grains from pests. Hyperglycemia following its ingestion has been already reported in the recent years but severe hypoglycemia is uncommon. Here, we report a 19 year old male who attempted suicide with one tablet of AlP and demonstrated severe hypoglycemia. Despite restoration of blood glucose concentration to normal, he failed to respond to supportive treatment and died. The possible mechanisms leading to severe hypoglycemia are discussed. Though severe hypoglycemia is rare following AlP poisoning, physicians managing such patients should be aware of it. [ABSTRACT FROM AUTHOR]