title: Acute drug overdose: clinical profile, etiologic spectrum and determinants of duration of intensive medical treatment.
abstract: OBJECTIVE
  Acute drug overdosing is an important cause of organ dysfunction and metabolic derangements and the patients often require intensive care. This study aims to determine the clinical pattern of severe drug overdose as well as the factors influencing the duration of intensive care
  
  
  METHODS
  The clinical characteristics and course of consecutive adult patients admitted with a diagnosis of acute drug poisoning in the ICU of a tertiary hospital in Oman from January 2007 to December 2008 were reviewed retrospectively from the electronic case records.
  
  
  RESULTS
  Acute drug poisoning (n=29) constituted 3.9% of admissions to the ICU. Mean age was 29.38±7.9 years. They were brought in by their relatives (72%) or the state services (24%). Accidental poisoning was noted in 21 patients (72%) and suicidal overdosing in 6 (21%). The commonest drug was an opioid (65.5%). Glasgow Coma Scale score of ≤8 was recorded in 18 (62.1%). Sixty two percent of patients required mechanical ventilation. The prominent complications were hypotension in 9 (31%), pulmonary in 19 (65.5%), hepatic in 18 (62.1%) and renal in 12 (41.4%) patients. The major electrolytes abnormalities were low bicarbonate in 11 (37.9%), hyponatremia in 5 (17.2%) and hypokalemia in 4 (13.8%). Patients stayed in the ICU for 1 to 20 days (median-2 days). Factors associated with a longer ICU stay included hypotension upon arrival (p=0.048) and the need for mechanical ventilation on the first (p=0.001) and second (p=0.001) days of hospitalization. There was no mortality.
  
  
  CONCLUSIONS
  Early and prompt intensive medical therapy in acute drug poisoning can favorably influence the outcome. In addition, the presence of hypotension and requirement of mechanical ventilation on the first two days of hospitalization were responsible for prolonged ICU stay.
authors.affiliation: Department of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
authors.forename: B
authors.initials: B
authors.lastname: Jayakrishnan
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Asmi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Qassabi
authors.forename: R
authors.initials: R
authors.lastname: Nandhagopal
authors.forename: Irshad
authors.initials: I
authors.lastname: Mohammed