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Background: The poisoning is mostly due to suicide and is observed in younger age groups. The systemic manifestations of ALP poisoning are common but pernicious manifestations of them are cardiotoxicity, shock, and ARDS. The clinical hallmark of cardiotoxicity is arrhythmia. The aim of this study was to investigate cardiac arrhythmias in patients poisoned with ALP who were admitted to Razi Hospital to reduce mortality rate.
Methods: This survey was performed as a cross sectional descriptive study. Overall, 102 patients were admitted to the hospital. Their gender, age, first blood pressure (BP), and the number of consumed tablet were registered. A cardiologist studied the patients’ ECGs and recorded various arrhythmias. Then, data were analyzed using SPSS version 11.
Results: In this study the mean age was 29.75±14.34 years and 66.7% of the patients were male. Used tablet and first BP average were 1.74±1.25 and 69.51±27.31 mmHg, respectively. Arrhythmia was recorded in 75.5% of the patients, among which arterial fibrillation (AF) was the most prevalant with the rate of 40.3%. PVC, Junc and PAC were the most common arrhythmias, respectively. Another arrhythmia was categorized in one group. All kinds of arrhythmia were common in younger males who had used more than one tablet and had first BP less than 90 mmHg. All patients with arrhythmia died.
Conclusion: Cardiotoxicity is an important cause of death in all studies and in this study as well. All patients with arrhythmia, demonstrated through ECG, died. Therefore, this study can be the basis for more detailed studies.

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Background: Botulism is caused by a neurotoxin produced from the anaerobic, spore forming Bacterium clostridium. Food-borne botulism is one of the dangerous forms of food poisoning in the world. The purpose of this study was to survey some clinical presentations and laboratory findings in patients suspected with botulism toxicity that had received anti-botulism.
Methods: This descriptive-retrospective study was done on food-borne botulism poisoning cases admitted to the emergency ward and received anti-botulism at Razi Hospital of Rasht (north of Iran) during 2001-6. Completion of the questionnaire which included such variables as gender, age, clinical presentations, and laboratory data was based on the information available on the patients.
Results: Of the 31 patients that had taken anti botulism, 20 cases (64.5%) were male. Subjects were in age range of 19-55 and the mean of age was 34.5 years. Conserved foods (38.7%), salted caviar (32.3%), and fish (16.3%) were the main causes of botulism, respectively. The most common clinical symptom was vomiting (77.4%) and the most common neurological presentations were visual abnormalities (48.4%). Azotemia, leukocytosis, and leukopenia were seen in 3 cases (9.7%), in 2 cases (6.5%), and in 4 cases (12.9%), respectively.
Conclusion: Marine products (salted caviar and fish) have an important role in the incidence of botulism in Guilan. Botulism is seen in males more than females and its most common clinical manifestation is vomiting.

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ABSTRACT
Introduction: Frequency of Tramadol intoxication is increasing as a result of its use as a drug for suppression of withdrawal symptoms by opioids abusers and its wide accessibility of this drug. Tramadol intoxication can lead to death and, therefore, early identification of its clinical manifestations is crucial since early detection of the intoxication and its treatment could improve patients' survival This study investigated the frequency of clinical and laboratory findings in Tramadol intoxication.
Methods: In this cross-sectional study, patients with Tramadol intoxication who referred to Razi Hospital in Rasht, Iran, during 2005-06 were examined. Their medical records were surveyed for demographic data, past medical history, neurological examination, and routine laboratory tests. All data were statistically analyzed by SPSS software version 14.
Result: The majority of the 306 patients (83.3% male) were in the age range of 20-40 years and 68.6% of them had been educated up to high school. The mean dose of ingested Tramadol was 746± 453mg (mean± SD). Agitation (25.2%) and seizure (20.3%) were the most frequent reported symptoms. Among laboratory abnormalities, the most common findings were prolonged PT (18.3%) and increased ALT (5.6%).
 Conclusion: The most common clinical presentation was agitation and the most common laboratory finding was prolonged PT. Of all the patients, 3 cases were admitted to ICU. Although Tramadol poisoning might lead to death, there was only one death after Tramadol poisoning in the current study.

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Background:Naltrexone is a competitive opioid receptor antagonist blocking the euphoric effects of exogenous opioids. When used concomitantly with opioids, naltrexone causes severe withdrawal symptoms.The main aim of the study is to determine the symptomatology and outcome of patients who consumed naltrexone in conjunction with an opioid substance.
Methods:This cross-sectional study was performed on the patients hospitalized with history of naltrexone usage coincided with opioid substances at Razi Hospital, Rasht, Iran. The collected data were demographic information, abuse information, clinical signs and symptoms, laboratory findings, and therapeutic measures taken. Data analysis was performed by descriptive tests using SPSS software version 16.
Results: The mean age of the patients was 33.7±10.2. The majority of the cases were male (95.6%) and urban (96.7%). The main cause of withdrawal symptoms in 91.1% of the patients was inappropriate naltrexone usage.The main poisoning agent in 80% of the cases was consumed naltrexone alone. The route of consumption in 90.1% of the cases was oral and in 9.9% the cases was IV injection. The major clinical features were nausea, vomiting, and agitation.The main therapeutic measures were supportive intravenous fluids (94.8%) and opioid administration in the form of methadone. The mean hospitalization period was 21.8±18 hours.
Conclusion: Severity, clinical course, and outcome of opioid withdrawal by accidental or intentional naltrexone abuse varies greatly among patients and is unpredictable. Common findings upon presentation were gastrointestinal symptoms and agitation and the main therapeutic measures for these patients were support with intravenous fluids and anti-nausea drugs administration as plasil and opioid administration as methadone.

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Background: Acetaminophen is widely used as an analgesic and antipyretic drug and it is a frequent cause of acute drug poisoning.This study was carried out to investigate the demographic information and clinical and laboratory findings in acetaminophen poisoning patients referred to “17 Shahrivar” and “Razi” educational hospitals, Rasht.
Methods: In this retrospective cross-sectional study, 125 patients with acetaminophen poisoning were studied. Descriptive data were analyzed by SPSS software.
Results: 90 of the patients were women and the mean age of the patients was 21.5±9.06 years. Also, 72.8% of the patients were from urban areas and most of the patients (67.2%) lived in Rasht. Spring was the most common season for the incidence of poisoning. Suicide was the most common pattern of poisoning (91.2%). The mean time interval between poisoning and use of antidote N-acetylcysteine was 4.94±3.5 hours. The most common cause of delayed administration of antidote was failure in diagnosis of poisoning. Overall, 31.2% of the patients had no significant clinical manifestations. In other patients, nausea (50.4%) was the most common clinical symptom. The most common abnormal laboratory findings were prolonged prothrombin time and international normalized ratio (29%). Liver aminotransferases were elevated only in 18% of the patients.
Conclusion: Poisoning with acetaminophen was mainly found in women, 12-20 years of age, in urban areas and spring season. Suicide was the main reason of poisoning. Regarding the most common cause of delay in antidote therapy (failure in poisoning diagnosis), establishment of a toxicology laboratory in Guilan province can help the better management of poisoned patients.

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Background: Cardiac manifestations that occur in a majority of patients with organophosphate (OP) poisoning may range from innocuous electrocardiographic manifestations, such as sinus tachycardia, to life-threatening complications, including cardiogenic pulmonary edema and myocardial necrosis. In this study, we evaluated the various electrocardiographic manifestations in patients with OP poisoning.
Methods: This retrospective-descriptive study was performed by reviewing the medical records from all patients poisoned with organophosphate admitted to Razi Educational Hospital, Rasht, Iran, from April 2008 to March 2011. Patients with incomplete records were excluded from the study. Histories of all patients were collected and ECG analysis was conducted including the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals by a cardiologist. Descriptive statistical analysis was conducted by SPSS software version18.
 Results: Of the total 100 patients (75 were male) with OP poisoning that referred to the Emergency Ward of Razi Hospital, 63 patients presented ECG abnormalities. The mean age of the patients was 35.78 ± 12.91 years. The causes of poisoning were occupational in 71 patients, suicidal in 26 patients, and accidental in 3 patients. Sinus tachycardia (31%) was the most common ECG abnormality, followed by non-specific ST-T changes (24%). Overall, mortality rate was 5% and all of the deceased patients presented changes in ECG.
Conclusion: OP poisoning is associated with significant ECG abnormalities, especially tachycardia and non-specific ST-T changes.

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Background: Aluminum phosphide (ALP) or rice tablet is a common agent used as pesticides. It is cheap, widely available and highly toxic and responsible for many cases of poisoning in the agricultural communities. There is limited evidence about change of liver enzymes in patients with ALP poisoning in this region. Therefore, we decided to evaluate alteration of liver enzymes in ALP poisoning in Rasht. Methods: In this retrospective cross-sectional study, all documents of patients with ALP poisoning admitted to Razi hospital of Rasht in 2008-2009 were assessed. Inclusion criteria were diagnostic clinical manifestation such as hypotension or metabolic acidosis, history of exposure to ALP during the past 24 hours and progressive signs and symptoms despite treatment (administration of sodium bicarbonate and vasopressor). Patients with past history of hepatic disease were excluded. Collected data were analyzed with SPSS software.
Results: Of 104 patients with ALP poisoning, 66 patients (63.5%) were men. The mean age was 33.8±14.69 years, and the mean time of hospitalization was 14.94±18.28 hours. Ninety-five patients (91.3%) needed ventilation and 93 patients (89.4%) died. Statistical analysis demonstrated that elevated liver enzymes were not significantly related with gender, age, time of admission, time of hospitalization, the need for ventilation and mortality.
Conclusion: It seems that liver enzymes changes is not seen widely in ALP poisoning and had lower importance than other complications. Because of limited studies in liver enzyme alterations in these patients, it is suggested that more studies with largee sample size is performed to investigate the ALP liver side effects.

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Background: Caustics produce one of the most serious complications of poisonings. This research was aimed to study demographical, clinical and endoscopic findings in patients with corrosive injury.
Methods: In a retrospective survey, all records of the patients who had been admitted to Razi and 17th Shahrivar hospital in Rasht city due to the ingestion of caustic agents during 2002-2009 and endoscopy had been performed for them in the first 24 hours after ingestion were studied. The information was analyzed by descriptive method using SPSS 16 software.
Results: Among 258 patients in Razi Hospital, 174 (67.4%) were female with mean age of 29.33 years old. 127 patients (61.1%) had intentional ingestion. 208 patients were finally studied. Among them, 175 patients were hospitalized for 2 days (average 1.73 days). Among 45 patients of 17th Shahrivar hospital, 24 (53.3%) were female. All of them had accidental ingestion. The most frequent site of injury in adults was esophagus (37.2%) and in pediatric population was the mouth (66.6%). Of all pediatric patients, one case had grade IIb endoscopic injury. Among cases who underwent endoscopy (in adults),20.8%, 16.7%, 41.6%, 16.7%,4.2% had grade zero, I, IIa, IIb and III injury, respectively .In all cases, bleaches were the most frequent consumed material.
Conclusion: In both studied groups, female patients were more affected by corrosive agents and in adults, intentional ingestion was approximately 1.5 times more frequent than the accidental cases while all of pediatric patients had accidental poisoning. Most of the lesions had been received only medical treatment without any surgical interventions.

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