A Study of the Toxic Causes of Cardiac Arrest in Overdosed Patients Presented to Mansoura Emergency Hospital from March 2008 to March 2010

Toxic cardiac arrest is an uncommon manifestation of overdose. The present study aimed to evaluate
the toxic causes of cardiac arrest in overdosed patients presented to the Toxicology Unit in Mansoura
Emergency Hospital in the period between Mars 2008 ro Mars 2010. At the end of the study period,Jorty
five cases presented with toxic cardiac arrest. 91.1% were men (41 cases) and 8.9% were women (4 cas
es), most of the cases were in age group 20-29 (53..3%). From all patients history and clinical examina
tion were done, 20 ml urine and 5 ml blood samples were collected. Samples were screened by Enzyme
Multiplied lmmu110assay Technique (EMIT) and the positive results were confirmed by Thin layer Chrom
atography (TLC). Tramadol was screened in all urine samples by TLC. The study revealed that the per
centages of positive results using EMiT for opiates, cannabinoids, benzodiazepines, barbiturates, ethyl
alcohol, tricyclic antidepressants (TCA) a11d digoxin were (15.6%, Il.l%, 68.9%, 8.9%, 6.7%, 11.1%
and 89% ) respectively. The mean digoxin level was 6.5 :!:1 29 nglml. Six cases were diagnosed by the
history and clinical examination as organophosphorus poisoning and confirmed by doing pseudo-choline
esterase level with a mean level of 497.75Il49.8 IV. Confirmatory testing of positive results by TLC as
regards cannabinoids, bem .. odiazepines, barbiturates and opiates (morphine, codeine and 6 mono-acetyl
morphine) were ( 11.1%), (28.8%), ( 11.1%) and (15.5%) respectively. Tramadol and tramadol co
ingestions positive results (7 and 12 cases respectively) represemed about 42.2% of ail cases. The com
monest tramodol co-ingested substance was benzodiazepines (7 cases). Jn conclusion, the previously de
clared results revealed that the most common toxic cause of cardiac arrest is tramadol; as drug of abuse;
whether used single or co-ingested especially with benzodiazepines. Finally, we recommend increase the
scope of drug screen and confirmation methods to cover a big numbers of drugs.