Acute theophylline overdose is a common medical problem in emergency toxicology departments, it causes serious complications that may lead to death. The Aim of this study is to explore if serum theophylline level is corresponding to development of complications and prolonged hospital stay after acute overdose .Methods: The prospective study included 510 cases admitted to the PCC ASU hospitals during the year 2016.The cases were categorized in two groups; group I(non complicated cases) and group II(complicated cases). All cases were subjected to full history, clinical data and detection of acid base status and ECG performance. Emergency interferences were evaluated. Results: All cases were suicide, 3 cases were died. There was significant difference between groups I and II regarding age, delay time, temperature, vomiting and grade III vomiting, high significant difference regarding hypotension needed IV fluids, very high significant difference regarding pulse, extreme significant difference regarding systolic and diastolic blood pressure, sinus tachycardia, respiratory manifestations and grade I and II vomiting. The frequency of complications during hospital stay was respiratory alkalosis then metabolic acidosis, hematemesis and /or melena, respiratory distress, arrhythmia, agitation, respiratory acidosis and seizures. Regarding ECG Changes in both groups, atrial fibrillation, ventricular tachycardia and cardiac arrest occurred in 3% of group II. There was extreme significant difference regarding admission to ICU and duration of hospital stay. Activated charcoal, multiple dose activated charcoal and IV fluids were given to all cases of group II with extreme significant difference between both groups regarding multiple dose activated charcoal, gastric lavage and IV fluids. Gastric lavage was done to most of group II cases with extreme significant difference from group I, there was very high significant difference between both groups regarding anticonvulsant administration. There was high significant difference between group I and II regarding peak serum level of theophylline. Regarding relation between serum theophylline level and occurrence of complications, extreme significant difference was found between group I and II regarding metabolic acidosis and hematemesis and/ or melena, very high significant difference regarding arrhythmia and hypotension that needs vasopressor and high significant difference regarding respiratory distress. Regarding relation between peak serum theophylline level and duration of hospital stay, there was high significant difference between the groups for all periods. Conclusion: It was concluded that there was significant difference between the two groups regarding peak serum theophylline level and occurrence of complications and also duration of stay. Recommendations: Serum theophylline level should be considered to be one of the predictors of occurrence of complications, ICU admission and longer duration of stay in acute overdose cases.

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Background: Organophosphates are highly toxic compounds for human beings. Organophosphate compounds (OPCs) poisoning by unintentional or suicidal ingestion is associated with high morbidity and mortality, particularly in developing countries. Aim of the study: Assessing the prognostic value of red cell distribution width (RDW) and white blood cells (WBCs), hemoglobin and platelet count on severity and outcome in patients with acute organophosphate poisoning in conjunction with clinical signs using the Peradeniya Organophosphorus Poisoning (POP) score. This is in addition to evaluation and comparison between RDW with pseudo choline esterase (PChE) level as early OPCs poisoning predictor. Methods: A prospective cross-sectional study was done on 100 acutely OPCs intoxicated patients admitted to Poison Control Center Ain Shams University Hospitals (PCC-ASUHs) from June 2019 till December 2019. All cases were clinically evaluated. RDW was done on admission and after 24 hours while WBCs, hemoglobin, platelets, PChE level and arterial blood gases (ABG) were estimated immediately after admission prior to treatment. Results: High RDW values indicated poor prognosis. There was a highly significant correlation between RDW values and the need for mechanical ventilation (MV). There was a significant correlation between high WBCs count, severity of OPCs poisoning and the need for MV. Lower mean pH, higher mean PCO 2 , lower mean HCO 3 , lower mean PChE levels, and higher mean WBCs count were noted in patients on MV compared to patients without MV. Conclusion: RDW values on admission can be a reliable predictor of severity and outcome in contrast to PChE levels which showed nonsignificant correlation with severity. Additionally, there was a significant correlation between WBCs with the need of MV. RDW on admission can predict the need for mechanical ventilation with sensitivity (58.97%), specificity (83.61%) at cutoff value more than 14.4. RDW on admission had a sensitivity of 75% and specificity of 73.75% with a cut-off value of 14.3 in predicting mortality in patients with OPCs poisoning. Recommendations: RDW is a simple parameter that could be used in assessing the prognosis of acute organophosphorus poisoning. WBCs count could also be used in those patients to predict the need of MV.

Background: Organophosphate compounds (OP) have been used as pesticides and chemical warfare nerve agents worldwide. They are readily available because of inadequate regulations controlling their sale. The easy availability of these compounds has resulted in a gradual increase in accidental and suicidal poisoning. It also has resulted in many deaths that occur within hours of the ingestion. The efficacy of the traditional treatment of OP which includes atropine and oximes still an issue of debate. Aim of the Work: Assessing the potential role of intravenous MgSO4 administration on the outcome of acutely OP intoxicated patients via a prospective single-blind randomized controlled trial in the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH). Patients and Methods:The study assesses the potential role of intravenous MgSO4 administration on the outcome of 40 acutely OP intoxicated patients within the period from 8-11-2016 to 18-1-2018. The study is prospective single-blinded randomized controlled trial that was carried out on patients admitted to (PCC-ASUH) with acute OP toxicity. Patients were divided according severity into moderate and severe groups then each group was subdivided into two subgroups; one received MgSO4 and the other didn't receive it. MgSO4 treated patients received 4g/d for only the first 24 hours after admission. Patients were observed for outcomes such as; mortality, total duration of hospital stay, need for ICU admission and its duration and intermediate syndrome and CVS toxicity occurrence. Results: There was no significant difference in duration of ICU stay, total duration of hospital stay and need for mechanical ventilation between MgSO4 treated and non-treated patients. MgSO4 administration may have decreased mortality, intermediate syndrome and CVS toxicity, but the difference was statistically insignificant between MgSO4 treated and non-treated patients Conclusion: Our study found that intravenous MgSO4 administration didn't modify the total dose of atropine and oximes given to OP intoxicated patients during their hospital stay, also MgSO4 didn't modify the need for mechanical ventilation. Although MgSO4 had reduced the number of patients who developed intermediate syndrome and CVS toxicity, duration of ICU stay, total duration of hospital stay and mortality, but unfortunately this reduction was statistically insignificant.

Viper species are distributed allover Egypt. Venomous bites by Viperidae snakes are associated with local and systemic manifestations and may be exacerbated by the development of acute kidney injury (AKI). THE AIM of the study was to assess acute renal injury in cases of envenomations by locally prevalent vipers as regards incidence, clinical and laboratory parameters and final outcome. METHODS:The current study was conducted on all patients, of both sex, admitted in Poison Control Center of Ain Shams University hospitals following envenomation by Viperidae snakes during 2014, 2015, and 2016. Diagnosis was based on history of snake bite with suggestive clinical data. Recorded data included patient characteristics (age, gender, delay time), vital data (heart rate, blood pressure), presence of local signs, bleeding manifestations, laboratory parameters (INR, platelet count, hemoglobin level, BUN and serum creatinine), number of antivenom vials used , duration of hospital stay and survival. Cases were sub-grouped to group I with AKI and group II without AKI. RESULTS: A total of 120 cases of venomous bites by Viperidae snakes were recorded during the study period with mortality of 4.2%. Cases were predominantly males with mean age of 35 +/-14.7years. A subset of 5.8% cases developed AKI which statistically was related to older age, longer delay time, increased incidence of bleeding manifestations and tachycardia, higher values of INR, serum creatinine, and blood urea nitrogen, lower platelet count, higher number of used antivenom vials and longer duration of hospital stay. Gender, hypotension, presence of local manifestations and hemoglobin level were insignificant among AKI. Mortality among AKI cases was statistically linked to old age, prolonged delay time, increased incidence of bleeding manifestations, higher INR values, low platelet count and low hemoglobin level and increased number of used antivenom vials and duration of hospital stay. The incidence of tachycardia, hypotension and local manifestations, serum creatinine and blood urea nitrogen levels were not statistically different among non-survivors. CONCLUSION: Acute renal injury may complicate the course of viper envenomations. Venom hemotoxicity is related to morbidity and mortality especially with older age and longer time between bite to antivenom therapy.