SEIZURES IN ACUTE POISONING IN CHILDREN AND ADOLESCENTS

– CLINICAL AND EVOLUTIVE CHARACTERISTICS –

 DISCLOSURE
SEIZURES IN ACUTE POISONING IN CHILDREN AND ADOLESCENTS
-CLINICAL AND EVOLUTIVE CHARACTERISTICS -
Nițescu G Viorela1,2, Marcu A Maria1, Mihalcea Ana-Maria1, Țurlea Teodora1, Coman I Irina1, Timofticiuc M Diana1, Popazu M Andreea1, Ulmeanu E Coriolan1,2
1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. “Grigore Alexandrescu” Clinical Emergency Hospital for Children, Bucharest, Romania
INTRODUCTION
Seizures are a major cause of morbidity and mortality from drug
overdose or poisoning (1)

Multiple or prolonged seizures may cause severe metabolic

acidosis, hypertermia, rhabdomyolisis and brain damage

Treatment is similar with that for seizures caused by other

pathology with some particularities

Phenitoin is innefective in drug-induced seizures and is not

recommended in the setting of drug overdose
OBJECTIVE
OBJECTIVE
To assess the main
characteristics and
clinical outcome of
seizures in acute
poisoning in children

The main Clinical

characteristics outcome
METHODS
RESULTS
• Analyzed period 2017-2022

3794
PATIENTS
49 patients
with
seizure(1.29%) 3745
without
seizure
 30

RESULTS 25

20
• Median age 12 years
15

• Male to female ratio :1:1

10

• Reason of poisoning 5

 Intentional poisoning :19 patients (38.8%) 0

1 month-1 year 1-3 years old 3-6 years old 6-12 years old 12-18 years
 Unintentional poisoning :30 patients (61.2%) old

Accidental Intentional
Male Female

n=19

n=25 n=24

n=30
 INVOLVED AGENTS
RESULTS CO

INVOLVED AGENTS Atropine

• CARBON MONOXIDE Izoniazide

(21 cases)
• Anti-inflammatory drugs
PSYCHOTROPIC
DRUGS(9 cases)
Cholinesterase inhibitory insecticides
• IZONIAZIDE(6 cases).
Psychotropic drugs

Atropine used in high doses New psychoactive drugs

as an antidot in acute
poisoning with Others
cholinesterase inhibitory
0 5 10 15 20 25
insecticides was identified as
causative agent in 5 cases
RESULTS New psychoactive drugs
Izoniazide
Psychotropic drugs
Others
Anti-inflammatory drugs

13%
INVOLVED AGENTS IN INTENTIONAL
POISONING - 19 patients
• PSYCHOTROPIC DRUGS (7 cases) 35%

• NEW PSYCHOACTIVE DRUGS (4

23%
cases)

10%
19%
RESULTS Others
7%

Organophos-
Involved agents in unintentional foric insecticide
17%
poisoning - 30 patients
• CARBON MONOXIDE (21 cases)
• ORGANOPHOSPHATE
INSECTICIDS (5 cases)
Psychotropic
drugs
7%

Monoxide
70%

Monoxide Psychotropic drugs

Organophosforic insecticide Others
RESULTS Type of seizures
2%
Type of seizures 16%

● Tonic –clonic generalized seizures -32 patients Tonic – clonic general-

(65.31%) ized seizures

● Hypotonic crises -8 patients (16.33%) Hypotonic crises

● Hypertonic crises -8patients (16.33%) Hypertonic crises

● Focal crise -1 child 16%
Focal crise

65%
RESULTS ASSOCIATED SYMPTOMS

ASSOCIATED SYMPTOMS CYANOSIS 10

• acidosis - 23 patients (46.9%)

• vomiting - 18 patients (36.7%)
MYDRIASIS/MIOSIS 10

• mydriasis/ miosis - 10 patients (20.4%)

• cyanosis - 10 patients (20.4%)
VOMITING 18
• coma - 12 patients (24%)

The probability of developing coma was shown ACIDOSIS 23

to be greater in multidrug intentional poisoning

(p<0.5). 0 5 10 15 20 25
RESULTS Recurrent
seizures
Prolonged
CLINICAL OUTCOME seizures >5
(18.37%) minute
Favorable (17.33%)
Outcome

Coma
Death (24.48%)
(2.04%)
*

- *This is a case of an intentional acute multi-drug poisoning, lidocain and substances of abuse (Cannabis, alcohol), in a 16-
year-old adolescent. She presented with generalized tonic-clonic seizures, was in a coma upon arrival at our hospital, was
intubated, and was admitted to the intensive care and anesthesia department
RESULTS

MAIN TERAPEUTIC
MEASURES

DIAZEPAM I.V. MIDAZOLAM OROTRACHEAL

OXYGEN INTUBATION
OR IR I.V.
 CONCLUSIONS
Seizures represent a rare but severe event in acute poisoning in
children and adolescents

The most frequent involved agents are carbon monoxid and

psychotropic agents

High doses of atropine used as antidot in pesticide poisoning can

cause or precipitate seizures in this patients

The probability of developing coma in acute poisoned patients with

seizures is significantly higher in acute intentional multidrug poisoning