الفهرس 
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Abstract
This work comprised the following:
I- Epidemiological Study:
Data regarding age, sex, occupation, education, special habits and residence.
II- Toxicological evaluation:
III- Estimate the maximum period of detection of these drugs in blood and urine.
IV- Relationship between Clinical Assessment and Drug Analysis.
1. History taking:
a- Social history including marital status, criminal consequences, and family problems
b- Past history including psychiatric illness, painful diseases, and diseases complicating
addiction.
c- History of addiction including type of the drug, route of administration,
duration of addiction, previous experience of overdose, cause of addiction, symptoms of abstinence,
and trials of treatment.
d- History of present illness including the cause of overdose, previous period of abstinence, and
presenting symptoms.
2. Examination:
General and local examination of respiratory, cardiovascular, gastrointestinal, and
neurological systems.
3-Investigations:
a- Routine investigation:
• Serum glucose level.
• Serum sodium level.
• Serum potassium level.
b- Specific investigations:
• Electrocardiogram.
• Blood gases profile.
• Liver function tests.
• Renal function tests.
• Blood and urine analysis for detection the maximum period that the drug stay in the body
4-Treatment:
Including emergency measures, methods of elimination, antidotes given, and symptomatic treatment.
*Epidemiologkal results:
The majority of the drug abuse related emergencies were in the age group 20-40 years (48%), males
(88%), unmarried (76%), and manual workers (28%). They belonged to different educational strata.
Toxicological evaluation:
1. History taking:
34% of cases had disunited families and 25% of cases had positive family history of drug abuse.
Most ofthe patients had traditional culture (95.8%). The commonest cause of drug abuse is the
association with friends who abuse drugs (38.8%), next to it are social occasions and despair
(12.9% for each of them). Other causes of drug abuse include curiosity, grief, to get high and
financial problems. History of psychiatric diseases was positive in 9.1% of cases.
Th commonest complication of drug abuse is hepatitis (76.9%).
Most of patients abused ethanol (20.5%), cannabis (29.5%), benzodiazepines ( 19%), amphetamines
(2.5%), methanol ( 14%) and
barbiturates (2%).
The circumstances of drug related emergencies were previous period of abstinence (35.3%), drug
combinations (22.9%), suicidal attempt (14.6%), increased dose (14.6%), and rubbery (4.2%). Other
causes are body smuggling, drug adulteration, change of drug and change of dealer (2.1% for each of
them).
2. Examination:
Abnormal heart rate was mostly associated with opiate, 50% of bradycardic patients and 50% of
tachycardic patients. Other causes for tachycardia were cannabis and methanol.
Hypotensive patients were taking opiate (60% of hypotensive cases), methanol (20Yo of hypotensive
cases), and benzodiazepines (10% of hypotensive cases).
Respiratory depression was mostly associated with opioid overdose, as 75% of apnic patients and 40%
of bradypnic patients were diagnosed as opioid overdose. Other drugs associated with respiratory
depression were methanol, eteanol, and benzodiazepines. Tachypnea was reported with methanol (17.6%
of tachypnic patients), ethanol (5.8% of tachypnic patients), and opiate (25% of tachypnic
patients).Hypotension was associated with opiate,and methanol.
The majority of opiate cases presented with coma or altered level of consciousness (88%),
respiratory distress or failure (36%), and hypotension or shock (24%).
Benzodiazepine abusers presented to the emergency room with altered level of consciousness (84.2%),
respiratory distress (23.7%), and hypotension (18.4%). Barbiturate abusers presented with
respiratory distress (25%), altered level of consciousness (25%), and vomiting (25%). Therefore, it
may be difficult to differentiate opioid overdose from sedative hypnotic overdase.
Most of ethanol abusers presented with vomiting (75.7%) and altered level of consciousaess (17.1%),
while methanol intoxicated patients presented with blurred vision or blindness (78.6%), altered
level of consciousness (60.7%), hypotension (32.1%), vomiting (25%), respiratory distress (7.1%),
and anuria (5.6%).Cannabis abusers mostly presented with psychosis.
Coma stage IV was related mainly to opiate (25%) and methanol (7%). In mosr of the opiate cases
presenting in deep coma (stage IV), pupils were constricted (86.3%), while they were usually
dilated in methanol poisoning (70.6%).
3- Investigations:
Blood glucose !eve\:
Hyperglycemia (15cases, 5.7%) was recorded with opiate (46.6% of hyperglycemic cases), methanol
(40%), benzodiazepines (6.6%), and ethanol (6.6%).
Hypoglycemia (8 cases, 4%) was reported with opiate (37.5% of hypoglycemic cases), methanol (50%),
and cannabis (11.1%).
Blood pbtassium level:
Hyperkalemia (8 cases, 8%) resulted from respiratory acidosis secondary to opiate overdose and
metabolic acidosis secondary to methanol intoxication.
Hypokalemic cases (9 cases, 9%) were associated with respiratory acidosis secondary to opiate
overdose, metabolic acidosis secondary to methanol intoxication, and normal ABG with unknown drug.
Arterial blood gases profile:
Metabolic acidosis was mostly seen with methanol, and ethanol, Respiratory acidosis was reported
with opiate, and ethanol, Respiratory alkalosis was reported with ethanol intake only.
Liver and kidney functions:
Imp’linnent of kidney function was related to opiate, methanol, and benzodiazepine. Liver functions
were impaired with opiate, and amphetamines.
Toxicological tests a11d drug screens of drug abuse to estimate the maximum period r,f
detection of these drugs in blood and urine:
Drug analysis varies according to type ofthe drug
-Alcohol detection varies from 10-12 hours.
-Cannabies detection in urine in single use from 2-6 days, in chronic use the samples became
negative after 32 days, and disappear in blood after 2 days
-Opiates detection in urine in single use from 1-3 days, in chronic use the
samples became negative after 7 days, and disappear in blood after 8 hours -Benzodiazepines detection in urine in single use from 1-4 days, in chronic
use the samples bec,arr.e negative after 28 days, and disappear in blood after 2 days
-Amphetamines detection in urine in single use from 1-2 days, in chronic use the samples became
negative after 4 days, and disappear in blood after 12 hours.
-Barbiturates detection varies from 1-4 days. and disappear in blood after 2
days
4-Treatment:
The most frequent emergency treatment is oxygen (33% of cases). The indications for its use were
respiratory distress, shortness of breath, panic attack associating cannabis, and coma. Other
emergency treatment included endotracheal intubation (5.5%), upper airway suction (2.4), and
CPR(!%).
The used antidotes were naloxone, flumazenil, ethanol, folate, vitamin B, and sodium bicarbonate.
*Relationship betV/een clinical assessment and drug analysis:
Relationship between clinical assessment and drug analysis of drugs of abuse for barbiturates,
methanol and ethanol, the agreement between clinical diagnosis and drug analysis was moderate. For
amphetamines and opiate the agreement was fair, but for benzodiazepines and cannabies the agreement
was considered to be poor.