INTERNATIONAL JOURNAL Of ACADEMIC RESEARCH
Vol. 3. No. 5. September, 2011, I Part
THE VALUE OF DRUG SCREENING BY ELECTONIC
APPLICATION SYSTEM IN UNINTENTIONAL POISONING IN
DAMMAM REGIONAL POISONING CONTROL CENTER-KSA
1
2
M. Al Mazroah , A. Refat *
1
2
Director of Dammam Regional Poison Control Center (DRPCC), Clinical Toxicology Staff
Member (DRPCC) Eastern Region, Ministry of Health (SAUDI ARABIA)
2
Lecturer of clinical Toxicology, Faculty of Medicine, Mansoura University (EGYPT)
*Corresponding author: ahmedrefat1973@yahoo.com
ABSTRACT
Background: Acute poisonings are common and frequently require acute triage regarding treatment.
Although most poisonings are treated supportively, the toxicological analysis may be helpful, but it is impossible for
routine clinical laboratories to provide a full spectrum of such tests. Objective: The main purposes of this review
are; i-to assess the usefulness of (Online Toxicology Analytical Results Request) and ii-OTARR systems to
evaluate usefulness of a comprehensive drug screen method as an important line diagnostic tool on clinical
toxicology decision leading to patient admission and further emergency toxicology care. Methods: The present
study was a part of a cross-sectional, multi-center study of all acutely poisoned patients of the online electronic
contact (OTARR) system in Dammam Regional Poison Control Center (DRPCC) which data were collected from
March 8th 2009 until March 7th 2011. Responsible physicians on duty completed a standardized OTARR electronic
form; which involved with several clinical and sociodemographic variables and toxic agents characters.
Toxicological laboratory analysis; gastric, blood and urine samples for toxicological screening were drawn as can as
possible for all; with electronic recording for the type of withdrawn sample (OTARR) and immediately sent to
DRPCC. A drug screen is a panel of laboratory tests performed upon biologic specimens to determine whether
drugs or foreign chemicals are present. Results: Young children age group less than six years was representing
23% of the unintentional poisoning and 74% of the intoxicated patient were male. 36% of unintentional intoxicated
cases were admitted. 44% of unintentional intoxicated cases were presented as asymptomatic presentation with
36% of overall toxicological procedures was positive results. The agreement between the clinical assessment and
toxicological laboratory analytical results were moderate to good with significant statistically for acetaminophen,
salicylates, carbamezapine, tricyclic antidepressant, ethanol and opiate; whereas moderate or fair without stastically
significant for other agents. Conclusions: As regards to its efficacy; it is recommended to activate the usage of
OTARR system in all KSA toxicology centers. The drug screening is a corner stone step in the indicating cases, and
whatever the result of the analytical toxicology procedures; all of them is highly supportive for the decision of
physician.
Key words: Drug Screening, Unintentional Poisoning, Asymptomatic Toxicity, OTARR and KSA
1. INTRODUCTION
Acute poisonings are common and frequently require acute triage regarding treatment. Although most
poisonings are treated supportively, guided by the clinical presentation, identification of the toxin agent may be important in poisonings requiring specific treatments or antidotes. Toxicological analyses may be helpful, but it is impossible for routine clinical laboratories to provide a full spectrum of such tests, some of which are rarely performed
1
and are time-consuming .
Patients present to the emergency department with acute symptoms and signs that have been poisoning in
the differential diagnosis. For notable examples are coma, seizures, agitation, delirium, psychosis, severe cardiovascular, gastrointestinal or respiratory instability. The clinician often turns to the gastric, blood and urine drug
screen as a diagnostic helping tool. From the previous conditions, acute poisonings may require identification of the
toxic: agents. It is impossible for routine laboratories to provide a full spectrum of toxicological analyses, and clinici2
ans should know the reliability of the clinical diagnoses of toxic agents .
Because many therapeutic measures in clinical toxicology are based on the initial clinical presentation, the
reliability of this clinical diagnosis should be compared with laboratory test results. Such studies have been perfor3
med, but with substantial differences in inclusion criteria, statistical methods and toxic agents measured . Some
studies included poisonings only resulted from deliberate self harm. Some compared only information from the patients instead of the complete clinical assessment with other toxicology laboratory results, and other studies involve
both intentional and unintentional poisoning. Some of the studies aimed to investigate the consequences of the differences between clinical and laboratory diagnoses. However, based on different results, conclusions varied from
recommendations of broadly based toxicology screening to advocacy of limited or more selected use of such
4,5
tests .
A drug screen is a frequent investigation in the emergency department. The purpose of ordering this test is
6
to determine whether the patient’s condition is due to a drug or not .
A major target in this study was the detection of the relationship between the degree of toxicity and the
results of different toxicological analytical procedures. Furthermore; because diagnostic and therapeutic strategies
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Vol. 3. No. 5. September, 2011, I Part
should he evidence based, and the results from previous studies were inconsistent, we wanted to perform a new
and larger study with the following aims; to determine the agreement between the overall clinical assessment on
admission and toxicological laboratory tests for a selection of common toxic agents, for all acute poisonings, in the
unintentional cases of toxicity.
We have thus had an opportunity to observe the pattern of unintentional poisoning; So the keystone of this
research; To address the questions-do you really need that online electronic clinical toxicology sheet application?
and emergency drug screen? With their online result recording? Accompanied by clinical toxicology consultation?
1.1. Aim of the work
The purposes of this research are; i-to assess the usefulness of (Online Toxicology Analytical Results Request) OTARR system in emergency toxicology. ii- to determine the magnitude of an unintentional toxic exposure
problem in Dammam city. iii- to evaluate usefulness of a comprehensive drug screen method as an important line
diagnostic tool on clinical toxicology decision leading to patient admission and further emergency toxicology care.
2. SUBJECTS AND METHODS
2.1. Design of the study
The present study was a part of a cross-sectional, multi-center study of all acutely poisoned patients of onlyne electronic contact (OTARR) with Dammam Regional Poison Control Center from (Dammam Complex Hospital)
(DCH) (Maternal and Child Hospital) (MCH) and (Al Jubail Hospital) (JH) in Dammam City-Eastern Region KSA;
during the previous two years.
Patients' online OTARR electronic applications were consecutively included in a retrospective design. This
paper presents data on the clinical and laboratory assessment of toxic agents from the hospitalized attendant toxic
suspected patients.
th
th
Data were collected from March 8 2009 until March 7 2011. The inclusion criteria for the present study
were an electronic application on OTARR system from responsible medical personnel with a main diagnosis of
acute poisoning, only unintentional toxic exposures. Exclusion criteria were intentional toxic exposure patients.
2.2. Data collection
Responsible physicians on duty completed a standardized OTARR electronic form; which involved with several clinical and sociodemographic variables and toxic agents characters.
The OTARR form contained multiple prefilled agent categories of several expected agents or agent groups,
including all agents analyzed in this study. In addition, an open field was left for agents not found in the list.
The physicians made an overall evaluation based on as much information as possible from patients, bystanders, clinical manifestations, and routine laboratory analyses.
2.3. Laboratory analysis
Toxicological laboratory analysis; gastric, blood and urine samples for toxicological screening were drawn
as can as possible for all; with electronic recording for the type of withdrawn sample (OTARR) and immediately
sent to DRPCC.
A drug screen is a panel of laboratory tests performed upon biologic specimens to determine whether drugs
or foreign chemicals are present.
There are several types of tests that can be used for drug screens. These include spot tests, thin layer,
chromatography, immunoassays, high-performance liquid chromatography, gas chromatography, and gas chromatography-mass spectroscopy.
Colour Tests; the following colour tests were done for different for different suspected toxicological cases
according to types of suspicious; paracetamol, rodenticide, barbiturates, cyanide, opiate, chemicals, salicylates and
vitamins.
One of the toxicology screening pathway was thin layer chromatography tests with the following criteria; the
solvent systems used in the TLC were alkaline, acidic, insecticides, folic acid and special systems. On the same
side; the spraying reagent that manufactured for developing spot were; iodoplatinate, dragndorff, palladium chloride, chromic acid and potassium permanganates.
The confirmatory pathway; for therapeutic drugs monitoring and drugs of abuse were Florized Polarization
Immunoassay y, Enzyme Multiplied Immunoassay, Gas Chromatography, Gas Chromatography and Mass
Spectrophotometery and Liquid Chromatography Mass Spectrophotometery.
2.4. Statistical analysis
Statistical Package Social Science (SPSS), version 19 Normality of data was detected by Kolmogorov-Samirnov test. Data was expressed as a percentage, range, mean +SD. Parametric tests, student (t) test and
Pearson’s Correlation coefficient (r) and Cohons Kappa value (K) were applied. A probability value (p) less than
0.05 considered to be significant.
Cohons Kappa value (K) measures agreement between the clinical assessment and the laboratory
analyses. K=1.0 indicates complete agreement, K=0.00 indicates no better agreement than chance, K> 0.21 was
considered fair, K>0.41 was considered moderate, K>0.61 was considered good and K>0.80 was considered very
good.
2.5. Ethics
Investigations and consultant protocols were done according to the standard toxicology laboratory and hospital consultation protocols, and in accordance with the most updated evidence base medicine. Permission was
obtained from the director of Eastern Health Affairs and DRPCC Ethics Committee. All data were immediately deidentified.
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3. RESULTS
The results of this study were tabulated, figured and analyzed according to the standard statistical methods
as follows:
Table (1); demonstrates the sociodemographic characters of the recorded OTARR cases: The total number
of OTARR recorded cases; from 11, March 2009 to 10 March, 2011, were 1786 recorded case; about 38% (691
recorded cases) was represented in the unintentional toxicity sector.
 Age: The age of the studied group ranged from 1 to 92 years with a mean +SD of 26.7 +18.6 years.
Twenty three percent was in the age group <six years group, 4.1% were in the age group 4-15 years group and
21.1 % were in the adolescent age group, 55.8 % were in age group 21-55 years and 5.8 were in the elderly age
group > 60 years.
 Sex: Seventy three point eight percent of the studied cases were males and 26.2 % were females.
 Occupation: Seventy three point eight percent of the studied cases were recorded on OTARR system
without a mention job description.14.2% were students and the remaining 12% of the studied recorded cases were
distributed among different jobs as the following 1% housemaid, 3.8% housewives, 1.6% security staff member,
2.2% drivers, 0.4% medical staff, 0.9% farmer and 2.2% industrial worker.
 Nationality: Seventy nine point six percent was Saudi; the remaining 10.4% were distributed among variable nationalities as shown in table (1).
Table 1. Demonstrates the sociodemographic characters of the studied OTARR cases
Parameter
Age:
<15 Year
15-50 Years
>50 Years
Total
Number
Gender
Male
Female
Occupation
Industrial
worker
Farmer
Medical
Staff
Driver
Security
Staff
House Wife
House Maid
Student
Other
Nationality
Saudi
Indonesian
Bangladeshi
Egyptian
Indian
Syrian
Jordanian
Sri Lankian
Filipino
Sudanese
Yemen
Nepali
Pakistani
Lebanon
Unknown
Number of Cases
Percentage
183
478
30
691
Minimum
1 year
Maximum
92 year
Mean + SD 26.7 + 18.6
26.5%
69.2%
4.3%
100%
510
181
73.8%
26.2%
15
6
3
15
11
26
7
98
510
2.2%
0.9%
0.4%
2.2%
1.6%
3.8%
1%
14.2%
73.8%
550
8
15
25
34
4
2
6
4
10
11
5
2
8
7
79.6%
1.2%
2.2%
3.6%
4.9%
0.6%
0.3%
0.9%
0.6%
1.4%
1.6%
0.7%
0.3%
1.2%
1.0%
Table (2); demonstrates the different therapeutic forms of poisons, mode and route of the poisoning process
in the studied recorded OTARR cases:
Therapeutic Poisoning Form: The tablet poison form represents 22.6% represent in the tablet form; 0.3 represent in the capsules form, 0.9 Effervescent form, 9.4% syrup form, 0.6% Syrup form, 0.1% Suspension Form,
0.1% Emulsion Form, Suppositories 0.1%, Lotion0.4%, Paints 0.3%, Mouth Wash 0.6%, Inhaler 0.3%, Injection
0.4%, Injection 1.0%, Patches 0.3% and 62.7% were represented other poisonous forms rather than therapeutic
forms as "plant, heavy metals, volatiles, chemicals and gaseous poisons".
Route of Poisoning: Thirty five percent of cases of OTARR reported cases were exposed to toxic exposure
by ingestion route; 1.6% by inhalation route, 0.1 by cutaneous route, 0.1% otic or aural, 0.4% by IM injection route,
0.3% by IV injection route, 0.6 by mucosal route and 10.4% by other routes. On the other side about 46.9% of the
OTARR recorded cases were represented with un-mentioned route of poisoning.
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Mode of Poisoning: Thirty eight point four percent of cases were situated in the acute single toxic exposure.
3% characterized by acute repeated exposure, 2.5% chronic exposure, 2.2% acute on top of chronic exposure and
54% of cases are reported on OTARR system without mention to the mode of poisoning.
Table 2. Demonstrates the different therapeutic forms of poisons,
mode and route of poisoning in the studied OTARR cases
Parameter
Poisons Forms:
Tablet
Capsules
Effervescent G.
Syrup
Suspension
Emulsion
Suppositories
Lotion
Paints
Mouth wash
Inhaler
Injection
Injection
Patches
Caustics
Hydrocarbons
Fumes and Gases
Unknown
Mode of Poisoning:
Acute Single Exposure
Acute Repeated Exposure
Chronic Exposure
Acute on Top of Chronic Exposure
Unknown
Route of Poisoning:
Ingestion
Inhalation
Cutaneous
Otic /Aural
Injection(IM)
Injection (IV)
Mucosal
Other
Unknown
Number of Cases
Percentage
156
2
6
65
4
1
1
3
2
4
2
3
7
2
37
20
6
370
22.6%
0.3%
0.9%
9.4%
0.6%
0.1%
0.1%
0.4%
0.3%
0.6%
0.3%
0.4%
1.0%
0.3%
5.4%
2.9%
0.9%
53.6%
265
21
17
15
373
38.4%
3.0%
2.5%
2.2%
54.0%
242
11
1
1
3
2
4
72
324
35.0%
1.6%
0.1%
0.1%
0.4%
0.3%
0.6%
10.4%
46.9%
Table (3); clarifies the degree of accidental toxicity; according to admission policy, toxicity grade scale and
level of consciousness in the studied OTARR cases:
Initial Toxic Severity Grade: Thirty seven point eight percent of cases of OTARR reported cases were attended to the emergency department without any toxic severity degree. 20.5% represent with a minor severity degree,
26.4% represent with moderate severity degree and 15.3% were situated in severe toxic degree.
State of admission: As referred to admission status of the studied OTARR cases; 63.8% were discharged
from emergency room, while 36.25 % were admitted in intensive care unit (ICU) or internal ward.
Table 3. Demonstrates the degree of accidental toxicity; according to admission policy and toxicity grade
scale and level of consciousness in the studied OTARR cases
Parameter
Initial Severity Degree:
No Severity
Minor Severity Degree
Moderate Severity Degree
Severe Degree
Admission Policy:
Admitted
Not Admitted
Conscious Level:
Disturbed Conscious Level
Fully Conscious
Number of Cases
Percent
Cumulative Percent
261
142
182
106
37.8%
20.5%
26.4%
15.3%
37.8%
58.3%
84.7%
100%
250
441
36.2%
63.8%
36.2%
100%
132
559
19.1%
80.9%
19.1%
100%
Table (4); clarified the different toxicological investigation results in accidental toxicity OTARR cases:
Colour spot test: Regarding positivity; 85.2% were giving Negative results and 14.8% were giving positive
results, which distributed as the following" 13.6% for paracetamol, 0.3% for salicylates, 0.2% for vitamin B6, 0.5 %
for opiates, 0.2% for vitamin D toxicity.
Thin Layer Chromatography: About 74.8% give negative results to thin layer chromatography procedures,
13% will give positive results to suspected poising and 8.6% well gave positive results for therapeutic medications.
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Confirmatory Toxicological Tests: From OTARR recorded cases about 34.2% were giving negative confirmatory results. While 64.1% were giving positive confirmatory results to suspecting toxicity. Finally only 1.7% was
giving positive confirmatory results for therapeutic medications.
Table 4. Demonstrates the different toxicological investigatory results in accidental toxicity OTARR cases
Parameter
Rapid Detecting Colour Tests:
Colour Tests Done
Colour Test Not Done
Types:
Paracetamol
Salicylates
Mefenamic Acid
Barbiturates
Rodenticides
Cyanide
Chemical
Vitamins
Results:
Negative Results
Positive Results
Paracetamol
Salicylates
Vit B6
Mariquies
Mefenamic
Vitamin D
Thin Layer Chromatography Tests:
TLC Tests Done
TLC Tests Not Done
Types:
Iodoplatinate
Dragndorff
KMNO4
Insecticides
Pallidium Chloride
Folic Acid
Number of Cases
Results:
Negative TLC Results
Positive TLC Results For Suspected Poisoning
Positive TLC For Therapeutic Medication
Immunoassay Tests:
TDM
DOA
Confirmatory Tests:
GCMS
LCMS
ICPMS
Results of Confirmatory Tests:
Total Case Number
Negative Confirmatory Results
Positive Confirmatory Results "Suspected Poisoning".
Positive Confirmatory Results " Therapeutic Medication".
Percent
645
46
93.3%
6.7%
618
605
586
597
36
17
8
7
89.4%
87.6%
84.8%
86.4%
5.2%
2.5%
1.2%
1%
543
94
86
2
1
3
1
1
85.2%
14.8%
13.5%
0.3%
0.2%
0.5%
0.2%
0.2%
626
44
90.6%
6.4%
614
115
76
54
51
3
88.9%
16.6%
11%
7.8%
7.4%
0.4%
465
77
51
78.4%
13%
8.6%
257
461
37.2%
66.7%
40
40
1
5.8%
5.8%
0.1%
117
40
75
2
100%
34.2%
64.1%
1.7%
Table (5); demonstrates the Bivaraite Correlation Coefficient among various toxicological procedures: there
was a nearly significant correlation between the colour tests and thin layer chromatography laboratory procedures
(r=0.07, p=0.09 and No =582), also between thin layer chromatography and different confirmatory procedures
(r=0.017, p=0.098 and No -96). While there was a non significant correlation between colour tests and confirmatory
procedures (r=0.07, p=0.46 and No= 104).
Table 5. Demonstrates the Bivaraite Correlation Coefficient among various toxicological procedures
Colour Test Results
r = 0.07
P= 0.09
No = 582
r = 0.073
P = 0.46
No=104
TLC Results
r = 0.17
P = 0.098
No = 96
Confirmatory Results
*Significant P value < 0.05
Table (6); demonstrates the integrated value between the clinical assessment and toxicological laboratory
results: Cohons K value shows fair agreement and no better agreement respectively between; the positivity of
colour tests, admission policy (0.24) and toxic severity state (0.18). Also there was a poor agreement between thin
layer chromatography with an admission policy (0.39). On the other and there was a fair agreement between the
TLC results with the toxic severity degree.
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Table 6. The integrated value between the clinical assessment and toxicological laboratory results
Colour Test Positive Results
TLC Positive Results
TDM Positive Results
Acetaminopen
Salicylates
Carbamezpine
Phenytoin
Phenobarbitone
Valporic Acid
Depakine
Tricyclic Antidepressant
DOA Positive Results
Amphetamine
Barbiturates
Ethanol
Cannabis
Opiates
Benzodiazepines
Admission Condition
Admitted - Not Admitted
K= -0.24
P value= 0.254
K= -0.39
P value= 0.175
Toxic Severity Degree
Present – Absent
K=0.18
P value 0.571
K=0.31
P value 0.003
K= 0.71
K= 0.54
K= 0.42
K=0.32
K= 0.46
K= 0.56
K= 0.27
K= 0.72
P value
P value
P value
P value
P value
P value
P value
P value
0.041
0.086
0.142
0.147
0.246
0.151
0.211
0.091
K= 0.210
K= 0.467
K= 0.512
K=0.320
K= 0.421
K= 0.360
K= 0.270
K= 0.358
P value
P value
P value
P value
P value
P value
P value
P value
0.131
0.231
0.030
0.147
0.210
0.151
0.841
0.212
K=-0.134
K=0.611
K= 0.521
K= 0.433
K=0.671
K= 0.320
P value
P value
P value
P value
P value
P value
0.095
0.241
0.311
0.211
0.022
0.412
K=-0.554
K=0.411
K= 0.311
K= 0.233
K=0.597
K= 0.548
P value
P value
P value
P value
P value
P value
0.150
0.341
0.005
0.130
0.003
0.108
*Significant P Value <0.05
Regarding admission policy with therapeutic drug monitoring; there was a good agreement between therapeutic drug monitoring (TDM) and the following drugs (Acetaminophen 0.71 and Tricyclic-Antidepressant 0.72).
Furthermore; the Cohons kappa value shows moderate agreement between the salicylates, carbamezapine,
phenobarbitone and valopric acid TDM tests and admission policy (0.54, 0.42, 0.46 and 0.56). While phenytoin and
Depakine TDMs tests shows poor agreement with an admission policy.
Toxic severity degree with therapeutic drug monitoring; there was a moderate correlation between carbamezapine, salicylates and phenobarbitone (0.512, 0.476, 0.421) respectively. Also; there was a fair correlation
between (valopric acid, tricyclic antidepressant, phenytoin and salicylates) (0.32, 0,358, 0.32 and 0.46).
The Cohons Kappa value (K) between the drug of abuse and the admission conditions showed; a good
agreement between the opiate and barbiturates drug of abuse results with the admission policy (0.611 and 0.671),
with moderate agreement between ethanol and cannabis drug of abuse results with the admission policy (0.521
and 0.423), Fair agreement with benzodiazepines drug of abuse results with the admission policy results (0.320)
and no better agreement with amphetamine drug of abuse results with the admission policy (0.095).
Finally; the Cohons Kappa value (K) between drug of abuse and toxic severity degree showed; moderate
agreement between amphetamine, opiates and benzodiazepines (0.554, 0,597 and 0.548) respectively. Also there
was fair agreement between; barbiturates, ethanol and cannabis (0.441, 0.311 and 0.233) respectively.
4. DISCUSSION
Many previous studies have shown that children under six years of age are particularly at risk from
7,8
accidental poisoning . Our study is in keeping with this finding as 23.1% (159/691) of the studied OTARR cases
were less than 6 years old.
Regarding to the gender in this study the percentage of unintentional toxic exposures in male was threefold
to the female; this result may be attributed to more outdoor activities of adult male with more occupational exposure
also may be due to more outdoor playing activities of pediatric males than female children with more exposure to
9
toxic agents; in a study in Malta the percentage of male to a female ratio of unintentional kerosene toxicity was
10
36% female and 64% male. On the opposite side; a study shows the percentage of the female to a male ratio in
accidental toxicity nearly equal 52.6% to 47.4%.
From the present study, the occupational toxic exposures from recorded OTARR cases were 8.3% which
mean the accidental toxicity from occupational exposure did not form in this study a major sector in the percentage
of overall forms of unintentional toxicities. The explanation of this resulted may be created from the main toxic
exposure source may be released from non-occupational factor rather than the occupational factor.
By referral to the nationality point, the majority of unintentional toxic exposure cases were Saudi (79.6%);
this percentage may be clarified by their involving the percentage of children (26.4%) and females (non Saudi
nationalities were not commonly accompanied with their families; wives and children)
The most common poisoning form involved in this study was tablet form (22.6%) followed by syrup form
(9.4) then caustic form 5.4% then hydrocarbon form 2.9%
10
In a study in Denmark , 180 of 524 unintentional pediatric cases (34%) admitted to a hospital with
poisoning were a household caustic poisoning form; while tablet form of household chemicals accounted for 45% of
the poisoning episodes. In this study, the commonest forms of poisoning involving were medicinal tablet and syrup
forms (22.6% and 9.4% respectively) then caustic form 5.4% and hydrocarbon form 2.9%. Medicinal Tablet and
syrup form with household chemicals are thus important sources of poisoning for studied cases and these tend to
be kept in easily opened or open bottles. Insecticides have a considerable potential form for harm, but they were
encountered in only four cases.
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From this study, the idea about the main form of toxicity was represented as acute toxicity due to exposure
to large toxic dose (38.4%). The most common poisoning route was an ingestion route which represents 35% of
11,12
the studied cases; the same were released from two studies
which stated that the most common route of
toxicity in accidental toxic cases was an ingestion route.
Unintentional toxic exposure cases were generally experienced only no and minor toxic severity grades
(58.3%) while severe toxicity was 15.3%. The no and minor toxic severity grades noted with ingestion of
medications may be related to the dose of drug ingested, induction of emesis and the type of drugs taken. These
observations contrast with the results of studies conducted in Qatar, where 17.8% had a severe symptoms, and
13
51.7% had been a mild to moderate symptoms .
Regarding the positivity rapid detecting colour test; 85.2% were giving Negative results and 14.8% were
giving positive results mainly to paracetamol intoxication13.6%, 0.3% for salicylates, 0.2% for vitamin B6, 0.5 % for
opiates, 0.2% for vitamin D toxicity the very limited number of substances which detected by rapid detection spot
14
test and the subjectivity of interpretative analytical result's repots similarly released from another study .
Thin layer chromatography can identify many substances. However, it is somewhat labor intensive and
15
requires a moderately skilled technologist who makes a subjective interpretation of the test ; these facts were
explained with the TLC results that ignited from this study as the positive valuable diagnostic indicative results from
different TLC procedures was 13% of acute toxicity OTARR recorded cases to suspected poising and 8.6% were
positive results for on situ therapeutic medications.
From Immunoassays are available for multiple substances. They can be done rapidly (laboratory turnaround
of less than 1 h), do not require a highly skilled technologist, and the result is objective. They may be designed to
detect a specific drug, a family of drugs, or a metabolite of the drug. Same to this conclusion were founded in our
immunoassay laboratory results than 64.1% of our laboratory results gave positive results with the suspected acute
toxicity cases that indicating for immunoassay procedures result with special confirmatory techniques (GC-MS,
HPLC_MS-MS and ICP_MS) for specific substance situations.
From the stastically results of this study, we found researchers found a nearly significant bivarient
correlation between (confirmatory test results and TLC results; p value=0.09) and (colour tests results and TLC
results p value=0.098) from the previous data the researchers concluded the highly sensitivity of the different
16
toxicological analytical procedures to confirm in step rise pathways. Same conclusive obtained by other study .
Agreement between clinical assessment (Admission condition and Toxic Severity Degree) with toxicological
laboratory analyses
Table 5 presents the frequencies of the clinically suspected agents and positive screening results of the
agents investigated in this study. K showed good agreement for acetaminophen, tricyclic antidepressant and opiate
with the admission condition, moderate agreement for carbamezapine and opiate with a toxic severity grade. The
good and moderate agreement may be attributed to the predominance in the of the previous clinical events with an
increase the clinical diagnostic sensitivity of the previous agents among clinicians. Same conclusion wear resulted
17,18
from other studies as
.
5. RECOMMENDATIONS
1-Regarding to its efficacy; it is recommended to activate the usage of OTARR system in all KSA toxicology centers. 2-Drug screening is a corner stone step in indicating cases, and whatever the result of the
analytical toxicology procedures; all of them is highly supportive to the physician decision. 3-By more meticulous careful electronic data entry by treating physician more accurate patient information can be obtained; with
overall clarification for diagnostic decisions.
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