Introduction: Amphetamine type stimulants (ATS) such as amphetamine and methamphetamine (MA) are one of the most important causes of poisoning in the world. In this study we aimed to define the predictive factors of mortality in acute ATS poisoning patients. Methods: This is a retrospective cross-sectional study on all cases with acute ATS poisoning who were referred to a referral center for poisoning, Tehran, Iran, from April 2011 to March 2014. Using patients’ medical records, demographic data, route of exposure, type and amount of ATS, the cause of poisoning, clinical presentations, and electrocardiogram (ECG) and laboratory findings, as well as patient’s outcomes were collected and analyzed regarding the independent predictive factors of mortality. Results: 226 cases with the mean age of 32.9 ± 10.9 years were studied (77% male). MA was the most abused ATS (97.4%) and the most frequent route of exposure was oral (55.3%). The mortality rate was 5.4%. There was a significant association between agitation (p = 0.002), seizure (p = 0.001), loss of consciousness (p < 0.001), creatine phosphokinase level (p = 0.002), serum pH (p = 0.002), serum HCO3 (p = 0.02), and PCO2 (p = 0.01) with mortality. However, serum HCO3 [OR=1.27 (95% CI: 1.07-1.50); p value=0.005], PCO2 [OR=0.89 (95% CI: 0.84-0.96); p value=0.002], and loss of consciousness [OR=0.019 (95% CI: 0.003-0.106); p value=0.000] were the only independent predictive factors of mortality. Conclusion: PCO2 ≥ 51 mmHg, serum bicarbonate ≤ 22.6 mEq/L, and loss of consciousness on admission could be considered as prognostic factors of mortality in acute ATS poisoning cases presenting to emergency department.
World Health Organization. Amphetamine-type stimulants. Available 1 August 2017. [Available from: www.who.int/substance_abuse/facts/ATS/en/.
Kumar MS, Kumar S. Amphetamine type stimulants (ATS) use in India- An exploratory study. United Nations Office on Drugs and Crime (UNODC); New Delhi, India, 2015.
United Nations Office on Drugs and Crime (UNODC), World Drug Report, Vienna, 2015.
United Nations Office on Drugs and Crime (UNODC), The Challenge of Synthetic Drugs in East and South-East Asia and Oceania, Vienna, May 2015.
Alam Mehrjerdi Z, Noroozi A. Methamphetamine intoxication in emergency departments of hospitals in iran: implications for treatment. Iran J Med Sci. 2013;38(4):347-8.
Bunting PJ, Fulde GW, Forster SL. Comparison of crystalline methamphetamine ("ice") users and other patients with toxicology-related problems presenting to a hospital emergency department. Med J Australia. 2007;187(10):564-6.
Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction. 2009;104(7):1085-99.
Yazdani MR TN, Masoumi GR, Gheshlaghi F, Dana-Siadat Z, Setareh M, et al. Demographic factors, duration and costs of hospitalization, and causes of death in patients intoxicated with opioids and amphetamines. International Journal of Medical Toxicology and Forensic Medicine. 2014;4(4):122-9.
Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S. Acute Adult and Adolescent Poisoning in Tehran, Iran; the Epidemiologic Trend between 2006 and 2011. Arch Iran Med. 2014;17(8):534-8.
Le Roux G BC, Lelièvre B, Bretaudeau Deguigne M, Turcant A, Harry P, et al. Recreational phenethylamine poisonings reported to a French poison control center. Drug Alcohol Depend 2015;154:46-53.
Jones AW HA. Amphetamine abuse in Sweden: subject demographics, changes in blood concentrations over time, and the types of co-ingested substances. J Clin Psychopharmacol. 2013;33(2):48-52.
Paydar P, Sabzghabaee AM, Paydar H, Eizadi-Mood N, Joumaa A. Outcome of treatment in patients with methamphetamine poisoning in an Iranian tertiary care referral center. J Res Pharm Pract. 2015;4(3):167-72.
Lan KC, Lin YF, Yu FC, Lin CS, Chu PL. Clinical manifestations and prognostic features of acute methamphetamine intoxication. J Formos Med Assoc. 1998;97(8):528-33.
Schifano F, Corkery J, Naidoo V, Oyefeso A, Ghodse H. Overview of Amphetamine-Type Stimulant Mortality Data - UK, 1997-2007. Neuropsychobiology. 2010;61(3):122-30.
Arendt M, Munk-Jorgensen P, Sher L, Jensen SOW. Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: A nationwide follow-up study of Danish substance users in treatment. Drug Alcohol Depen. 2011;114(2-3):134-9.
Behnoush B, Taghadosinejad F, Arefi M, Shahabi M, Jamalian M, Kazemifar AM. Prevalence and complications of drug-induced seizures in Baharloo hospital, Tehran, Iran. Iran J Toxicol. 2012;6(16):588-93.
Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, et al. Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN). Clin Toxicol (Phila). 2015;53(9):893-900.
Barati M, Ahmadpanah M, Soltanian AR. Prevalence and factors associated with methamphetamine use among adult substance abusers. J Res Health Sci. 2014;14(3):221-6.
Shams Alizadeh N, Moghadam M, Mohsenpour B, Rostami Gooran N. Prevalence of substance abuse in medical students of Kurdistan University. Scientific J Kurdistan Uni Med Sci. 2008;13(2):18-28.
Farhadinasab A, Allahverdipour H, Bashirian S, Mahjoub H. Lifetime Pattern of Substance Abuse, Parental Support, Religiosity, and Locus of Control in Adolescent and Young Male Users. Iran J Public Health. 2008;37(4):88-95.
Doaghoyan D, Habibzadeh Maleki A. Factors influencing the changing patterns of drug use among young people, from light drug to heavy drug. J Disciplinary Knowledge. 2011;13(1):105-33.
Khodabandeh F, Kahani S, Shadnia S, Abdollahi M. Comparison of the Efficacy of Methadone Maintenance Therapy vs. Narcotics Anonymous in the Treatment of Opioid Addiction: A 2-Year Survey. Int J Pharmacol. 2012;8:445-9.
Shariatirad S, Maarefvand M, Ekhtiari H. Methamphetamine use and methadone maintenance treatment: an emerging problem in the drug addiction treatment network in Iran. Int J Drug Policy. 2013;24(6):e115-6.
Smets G, Bronselaer K, De Munnynck K, De Feyter K, Van de Voorde W, Sabbe M. Amphetamine toxicity in the emergency department. Eur J Emerg Med. 2005;12(4):193-7.