Abstract
Children are highly sensitive to toxins which can damage their organs and lead to death. Investigating the main causes of intoxication could reduce mortality and morbidity in children. In this cross-sectional study, the documents of all poisoned patients (214 cases) admitted to the emergency department of Taleghani children`s Hospital between April 2020 and 2023 were investigated. Approximately 51% of them were females. There were 87 cases (45.3%) of illicit drug poisoning, which included methadone 43.8%, opium 41.4%, amphetamine 8.2%, cannabis 3.3%, buprenorphine 2.2%, and tramadol 1.1%. Children who were poisoned by illicit drugs presented with impaired level of consciousness (92.5%), unstable vital signs and abnormal laboratory results. The level of serum glucose was higher in methadone toxicity. Three and two cases, due to methadone and opium poisoning died. Children with illicit drugs poisoning in terms of vital signs and laboratory data were worse compared to other poisonings and mortality is high in this group. In this study, the blood sugar in methadone poisoning cases was statistically significantly different from other drugs, and it is suggested that in cases of children suspected of poisoning with illicit drugs and high blood sugar, methadone poisoning should be considered in the differential diagnosis.
Subject terms: Paediatric research, Epidemiology, Paediatric research
Introduction
According to the report of the World Health Organization (WHO), acute poisoning is the fourth most common cause of death in childhood. More than three million cases with acute intoxication are reported in developing countries, and in the United States, it was reported as one million cases1. The death rate in low-income countries is four times higher than in developed countries2. Poisoning is the cause of about 2% of all child deaths in developed countries and more than 5% in developing countries, in the US, the mortality rate of poisoning was 0.5 per 100,0001.
Children are highly sensitive to toxins due to growth and development, physiological and nutritional factors, which can damage their organs and lead to death2. Different social, economic and cultural situations cause different patterns of poisoning with a variety of toxic agents. These patterns vary from country to country and between geographical areas in the same country3.
In the research of Graham and et al. marijuana, cocaine and methamphetamine were abused more than other drugs, whereas, in other studies opioids and methadone were the most abused drugs especially in Iran4–6. Illicit drugs poisoning in children has a high frequency in abuser families reported in the US, about 12% of caregivers are dependent on or abusing drugs or alcohol, which leads to unintentional children`s exposures to illicit drugs or mistreatment of them, which is harmful to children`s health5.
Clinical manifestation of illicit drug intoxication vary and depend on the kind of substances, that maybe asymptomatic to neurological, gastrointestinal, and respiratory symptoms in children7,8.Based on laboratory data, hypoglycemia is the most laboratory finding in children with poisoning7.
Given the rising trend of pediatric poisoning with illicit drugs globally and particularly in Iran with substances such as opium and methadone, there is an urgent need to enhance health care provider`s understanding of the clinical manifestation and laboratory data associated with these intoxications1,6, and9. Despite the critical importance of data on intoxicated children, especially concerning illicit drugs, there remains a dearth of studies focusing on this issue. This study aims to fill this gap by comparing the clinical manifestations and laboratory findings of children admitted to hospitals for intoxications from illicit drugs versus other substances. Through this comparative analysis, we seek to delineate the differences and similarities in clinical presentations and laboratory results between these two categories of intoxicants. This knowledge is vital for developing targeted interventions and preventive measures aimed at reducing the morbidity and mortality associated with substance intoxication in pediatric populations.
Materials and methods
In the cross-sectional retrospective study, 214 patients who were admitted to the emergency department of the third-level university hospital in Gorgan due to poisoning during April 2020–2023 were studied. Educational and treatment Taleghani pediatrics hospital is the only referral children`s hospital in Golestan province under the supervision of Golestan University of Medical Sciences. Patients’ files including clinical manifestations and laboratory data were reviewed. All of the patients who were admitted in emergency ward less than 18 years old, without any chronic illness and with ingestion or inhalation of any substances ( Hydrocarbons, antidepressant, antipsychotic, antipyretic, antihypertensive, antihistamine, antibiotics drugs, pesticides and repellents) and illicit drugs (morphine, methadone, methamphetamine, buprenorphine, tetrahydrocannabinol, tramadol) were included in the study. The key exclusion criteria were the presence of any preexisting chronic illness, incomplete patient’s files with more than 10% missing data, and other intoxication that did not lead to hospitalization. Intoxication was diagnosed based on a combination of guardian’s reports, physician evaluations, and clinical manifestations. Response to antidotes when administered was also noted. Given the prevalence of negative urine screenings, confirmatory diagnoses were supplemented by clinical assessments and, when available, additional toxicology reports.
Data was collected through the completion of a form for demographic information (Gender, age, place of residence, year of admission, cause of intoxication, name of drug or substances were consumed) and clinical manifestations (level of consciousness ( Assessment tools AVPU, if the patients were under A level consider as impaired level of consciousness), 02 saturation, Heart rate, Respiratory rate) and laboratory data ( Arterial blood gas analysis (ABG), Blood sugar (BS), white blood cell count(WBC), Hemoglobin(HB), platelet (PLT), Aspartate aminotransferase (AST), Alanine transaminase (ALT), Serum Sodium, Serum potassium, urine toxicology) and outcome (complete recovery with discharge by physician decision, discharge without physician decision, referred to other hospital, death). Data were extracted from patient records, and the data were excluded if the data need to be incomplete or ambiguous. Cases with incomplete information and more than 10% of information items needed to be completed were presented in the overall report, but were excluded from the study in the description and analysis.
The data was statistically analyzed with SPSS software version 24. Frequency, percentage and mean were used to describe the data. The Chi-square test was used to compare the two groups and qualitied data. Kolmogorov-Smirnov test was used for assess the normality of blood Glucose levels, and Independent t-test was used for quantitative data and to compare the Mean Glucose levels in two groups. The significance level in this study was considered to be less than 0.05.
All methods described in our study were carried out in accordance with relevant guidelines and regulations. Specifically, data were extracted from patient records with their informed consent upon hospitalization. Since the study involved a retrospective analysis of existing patient records, no additional consent was required for the use of these records. Moreover, this project received approval from the Ethics Committee of Golestan University of Medical Sciences, ensuring adherence to all ethical standards for research involving human subjects.
Ethical Considerations: The Ethical Committee of Golestan University of Medical Sciences granted ethical approval for this study, which is documented under IR.GOUMS.REC.1401.506. In accordance with university regulations, informed consent for participation in academic research is obtained from all patients upon hospital admission. Due to the retrospective nature of this study, the need to obtain informed consent was waived by the Ethical Committee of Golestan University of Medical Sciences.
Result
In this study, 214 patients were admitted due to poisoning in the emergency department, and 87 patients (45.3%) were registered as poisoned with illicit drugs. Methadone 38 (17.8%), opium 36 (16.8%), amphetamine and methamphetamine 7(3.3%), Buprenorphine 2(0.9%), THC 3(1.4%) and Tramadol 1(0.5%) were reported.
The main other substances included Hydrocarbon 38(17.8%), antidepressant and antipsychotic drugs 29 (13.6%), antipyretic drugs 13(6.1%), and each other type of substances were less than 2%.
Demographic data
One hundred ten cases (51%) were females and 104 cases (49%) were males. In the illicit drug intoxication group 51.7% were female, and 48.3% were male. There was no statistically significant difference between gender and the use of illicit drugs (P-value = 0.54) (Table 1).
Table 1.
Variables in illicit drugs and other intoxication.
| Number (%) | |||||
|---|---|---|---|---|---|
| Illicit Drugs | Others | Total | P-value | ||
| Age | Under 6 months | 8(9.2) | 0 | 8(3.7) | 0.0001* |
| 6–11 months | 12(13.8) | 5(3.9) | 17(7.9) | ||
| 1–4 years | 48(55.2) | 54(42.5) | 102(47.7) | ||
| 5–9 years | 7(8) | 8(6.3) | 15(7) | ||
| 10–17 years | 12(13.8) | 60(47.2) | 72(33.6) | ||
| Year | 2020 | 7(8) | 7(5) | 14(6) | 0.75** |
| 2021 | 30(34.5) | 44(34.4) | 74(35.5) | ||
| 2022 | 50(57.5) | 76(60.6) | 126(58.5) | ||
| Causes | Intentional | 12(13.8) | 57(44.9) | 69(32.2) | 0.0001** |
| Accidental | 43(49.4) | 70(55.1) | 113(52.8) | ||
| Neglected | 32(36.8) | 0 | 32(15) | ||
| Gender | Girl | 45(51.7) | 65(51.2) | 110(51) | 0.54** |
| Boy | 42(48.3) | 62(48.8) | 104(49) | ||
| Residential Area | Urban | 51(58.6) | 70(76.9) | 121(67.9) | 0.007** |
| Rural | 36(41.4) | 21(23.1) | 57(32.1) | ||
| Consciousness | Aware | 6(7.5) | 45(55.6) | 51(31.7) | 0.0001** |
| Lethargic | 74(92.5) | 36(44.4) | 110(68.3) | ||
| O2 Saturation | Hypoxic | 6(8.1) | 1(1.3) | 7(4.7) | 0.01* |
| Normal | 68(91.9) | 75(98.7) | 143(95.3) | ||
| Heart Rate | Normal | 8(10.7) | 30(38.5) | 38(24.8) | 0.001* |
| Tachycardia | 66(88) | 48(61.5) | 114(74.5) | ||
| Respiratory Rate | Bradypnea | 16(21.3) | 14(17.9) | 30(19.6) | 0.3* |
| Normal | 56(74.7) | 56(71.8) | 112(73.2) | ||
| Tachypnea | 3(4) | 8(10.3) | 11(7.2) | ||
| ABG | Respiratory acidosis | 14(40) | 16(48.5) | 30(44.1) | 0.14 |
| Normal | 13(37.1) | 15(45.5) | 28(41.2) | ||
| Respiratory Alkalosis | 3(8.6) | 2(6.1) | 5(7.4) | ||
| Metabolic Acidosis | 5(14.3) | 0(0) | 5(7.4) | ||
| Blood Sugar | Normal | 66(83.1) | 69(98.6) | 132(92.5) | 0.13* |
| Hyperglycemia | 10(13) | 1(1.4) | 11(7.5) | ||
| WBC | Leukocytosis | 48(57.1) | 19(23.8) | 67(40.9) | 0.0001* |
| Normal | 35(41.7) | 60(75) | 95(57.9) | ||
| HB | Anemia | 31(36.9) | 15(18.8) | 46(28) | 0.01* |
| Normal | 53(63.1) | 65(81.3) | 118(72) | ||
| Platelet | Thrombocytosis | 11(13.1) | 1(1.3) | 12(7.3) | 0.008* |
| Normal | 73(85.1) | 79(97.5) | 152(91.5) | ||
| AST | High | 21(31.8) | 3(3.9) | 24(16.9) | 0.0001* |
| Normal | 45(68.2) | 73(96.1) | 118(83.1) | ||
| ALT | High | 4(6.1) | 2(2.6) | 6(4.2) | 0.31* |
| Normal | 62(93.9) | 74(97.4) | 136(95.8) | ||
| Sodium | Hypernatremia | 6(7.1) | 3(3.7) | 9(5.4) | 0.09* |
| Normal | 66(78.6) | 78(95.1) | 144(86.7) | ||
| Hyponatremia | 12(14.3) | 1(1.2) | 13(7.8) | ||
| Potassium | Normal | 81(92.9) | 78(95.1) | 159(95.8) | 0.21* |
| Hypokalemia | 3(3.6) | 4(4.9) | 7(4.2) | ||
| Outcome | Complete recovery | 33(35.8) | 26(31.8) | 59(33.7) | 0.54** |
| discharge without physician decision | 53(57.6) | 55(65.6) | 108(61.7) | ||
| Referred to other hospital | 1(1.2) | 2(2.6) | 3(1.8) | ||
| Death | 5(5.4) | 0(0) | 5(2.8) | ||
*linear by linear Association.
**Chi-Square.
The percentage of hospitalizations because of poisonings during the years 2020, 2021 and 2022 was about 14 (6%), 74 (35.5%) and 126 cases (58.5%), respectively. There was no statically significant difference between the year of admission and intoxication with illicit drugs (P-value = 0.75). The frequency of the causes of poisoning, including accidental, intentional and neglect of the caregiver, was 113 (52.8%), 69 (32.2%) and 32 cases (15%), respectively. Most of the cases (86.2%) of poisoning with illicit drugs were accidental or negligence of parents. The main causative factor was for the treatment of the child’s disease (in a few cultures opium was used for treatment of cough and diarrhea and infantile colic) or the negligence of the parents (some of parents who used methadone, keep the methadone syrup in other drug bottles that used it for their children by mistake, and there was a statistically significant difference between intoxication with illicit drugs in compare to other in term of causes. (Chi-square = 62.50, df = 2, p < 0.0001) (Table 1).
One hundred twenty-one cases (67.9%) lived in the urban area and 57 (32.1%) in rural areas. There was a statistically significant difference between the place of residence and the use of illicit drugs. The residential area of 58.6% of the poisoning cases in illicit drugs was in the urban area respectively. (Chi-square = 6.84, df = 1, p = 0.009). Eighty-seven cases were intoxicated with illicit drugs that 78.2% of them were under five years old, and 23% were under one year old. There was a statically difference between age and illicit drugs group. (Chi-square = 62.80, df = 2, p < 0.0001). (Table 1)
Clinical manifestation
Regarding the level of consciousness of poisoned patients, 92.5% of children poisoned with illicit drugs were lethargic compared to 44.4% of those poisoned with other substances. Patients with opium, methadone, buprenorphine, tramadol intoxication had myosis, bradypnea and lethargy. Intoxication with methamphetamine, and amphetamine was manifested by restlessness, mydriatic pupil, agitation, tachycardia and tachypnea. 4.7% of poisoning patients were hypoxic and 19.6% had bradypnea. 21% of poisoned children with illicit drugs had bradypnea versus 19.6% of other substances. There was no statistically significant difference between two groups regarding respiratory rate (P-value = 0.3). In this study, children who were poisoned by illicit drugs presented with significant statistically differences in impaired consciousness (Chi-square = 42.94, df = 1, p < 0.0001) and o2 saturation (Linear by linear Association = 6.68, df = 1, p = 0.01), Heart rate (Linear by linear Association = 11.61, df = 1, p = 0001) compare with other drugs (Table 1).
Laboratory data
In the illicit drugs group, respiratory acidosis was seen in 40% of patients and there was no significant difference between two groups. (P-value = 0.14)
It was reported that leukocytosis and anemia were 57.1% and 36.9% respectively, in illicit drugs. A statistically significant difference was reported between AST (Linear by linear Association = 19.39, df = 1, p < 0.0001), WBC (Linear by linear Association = 17.2, df = 1, p = 0.0001), HB (Linear by linear Association = 6.69, df = 1, p = 0.01), and PLT (Linear by linear Association = 7.06, df = 1, p = 0.008) (Table 1).
Urine toxicology tests were done in 164 cases, and frequency of various substances was morphine 21.3%, methadone 15%, benzodiazepines 5.6%, methamphetamine 1.9%, buprenorphine 1.4%, THC 1.4%, tricyclics1.2% and tramadol 0.6%.Negative urine toxicology tests were reported 43.9% (Table 2).
Table 2.
Urine toxicology results in patients. Frequency (%).
| Drugs | Frequency (%) |
|---|---|
| Morphine | 35(21.3) |
| Methadone | 32(15) |
| Benzodiazepine | 12(5.6) |
| Methamphetamine | 4(1.9) |
| Buprenorphine | 3(1.4) |
| Tetrahydrocannabinol | 3(1.4) |
| Tricyclic antidepressants | 2(1.2) |
| Tramadol | 1(0.6) |
| Negative | 72(43.9) |
| Missing | 50 |
| Total | 214 |
Out of 35 urine toxicology tests performed in opium poisoning, 24 cases were positive for morphine (68.6%), and 11 cases were negative (31.4%). A negative morphine test was reported in opium smoke poisoning.
Out of 37 urine toxicology tests performed in methadone poisoning, 30 cases (81%) were positive and 7 cases (19%) were negative.
Out of 5 cases of amphetamine poisoning, 1 case was positive for methadone, 2 cases were positive for methamphetamine, and 2 cases were negative.
Of the 11 cases of urine toxicology tests performed in clonazepam poisoning, one case of morphine, one case of methamphetamine, and one case of benzodiazepine were positive, and in the other 8 cases, the test was negative.
Moreover, out of 13 cases of urine toxicology test performed in alprazolam poisoning, one case was positive for morphine, 9 cases for benzodiazepine, and 3 cases were negative.
A statistically significant difference was reported between blood glucose levels and methadone poisoning. The average blood glucose level on admission in methadone poisoning had a statistically significant difference with other poisonings (Table 3).
Table 3.
Blood glucose level in methadone toxicity compared with other substances toxicity.
| Blood Glucose | Number | Mean | Std. Deviation | Std. Error Mean | Mean Rank | P-Value |
|---|---|---|---|---|---|---|
| Methadone | 31 | 138.7742 | 63.35283 | 11.37850 | 55.73 | 0.007 |
| Other substances | 59 | 101.2373 | 24.91111 | 3.24315 | 40.13 |
The average blood sugar in non-methadone poisoning was 101.23 ± 24.91 and in methadone poisoning it was 138.77 ± 63.35 (p-value = 0.007).
Discussion
Timely recognition and appropriate treatment of poisoning are crucial in reducing morbidity and mortality3,10.This study investigated the demographic data and clinical and laboratory symptoms of poisoning with illicit and other substances, focusing on children’s health.
The most common illicit substances in this research were methadone, opium, and amphetamine. Graham`s study identified Marijuana (37%) and methamphetamine (30%) as the main exposures in children, noting a gradual increase in these intoxications5. This difference is due to the varying availability of illicit drugs across regions. Alinejad`s study found that illicit drugs accounted for 19.3% of child intoxication, with opioids showing an upward trend from 2002 to 20191. Cheraghali et al., reported opium as the most common cause of poisoning (52.8% ) in 2002, with no methadone cases due to the absence of treatment centers then4. Other studies in Iran have observed a shift from traditional opium toxicity to methadone poisoning1,10,11.
Noori et al. found that among opium derivatives, methadone was the major cause of poisoning, followed by tramadol, and buprenorphine6. Manuchehrifar et al. reported methadone as the cause of 29.7% of unintentional poisoning10. In Ghafourian’s 2019 study, identified methadone as the cause of 60% of poisonings at the same hospital9.
Methadone poisoning is particularly dangerous in children, resulting in three deaths in our study. Noori reported two deaths from methadone and four from opium intoxication. Cheraghali found that 90.9% of poisoning mortality was due to opium and Beshart reported all four deaths in their study were from opium toxicity4,6, and12. Although the incidence of methadone toxicity has decreased, it remains the leading cause of child intoxication, requiring increased attention to accidental or neglected poisoning. Methadone maintenance centers should restrict the easy distribution of methadone syrup or tablets at home, methadone should be stored in child proof containers and kept out of children`s reach to prevent accidental poisoning.
This study found that 23% of children under one-year-old were intoxicated with illicit drugs, highlighting their higher availability and risk in neglected families. In some regional cultures, opium is used for treating cough, diarrhea, and colic. Graham’s study reported a median age of 2 years for poisoned children5, and Cheraghali found that 41.3% were under one year old4. Despite a decline in infant opium toxicity, educating addicted families and protecting neglected children through welfare organizations is essential.
Our study found that 68.3% of patients hospitalized in the emergency department were lethargic, consistent with other studies reporting impaired consciousness in 29- 77.7% of cases13–16. Cheraghali`s research noted neurological symptoms reported in 80% of patients, highlighting it as the most prominent symptom4.
The majority of illicit drug poisonings occurred in city dwellers. Other studies also found higher poisoning exposure among urban children1,11,12,17,18, likely due to larger populations and greater drug availability. However, Haratian and Besharat reported higher opium toxicity in rural areas11,12.
Nearly half of illicit drug intoxications were accidental, but many were intentional, with parents using drugs to calm or treat children, showing a significant difference. Cheraghali and Besharat highlighted the critical role of parents in poisoning cases, especially in infants, for conditions like diarrhea, agitation, insomnia, and respiratory infections4,12. Graham’s study reported 87% of intoxications as accidental and 2% as intentional, including abuse, misuse, and suicide attempts5. Children’s poisonings, whether accidental or intentional, indicate easy drug availability and lack of awareness. Such cases often occur in low socioeconomic families with inadequate child care. Health officials should educate these families on safe storage of illicit substances and methadone. Our study highlights the risk of false-negative lab tests for methadone and opium poisoning, emphasizing reliance on clinical symptoms and access history for diagnosis and treatment. Multiple drug use, especially among adolescents, should be considered by physicians, particularly with antipsychotic and antidepressant drugs, and in girls where intentionality may be higher.
Children poisoned by illicit drugs had more severe conditions compared to other drug poisonings, often involving preexisting diseases or poor socioeconomic conditions. These children need government and welfare support. Methadone poisoning cases showed high blood sugar levels, suggesting a need for refined diagnostic protocols in acute care settings.
The high prevalence of illicit drug poisoning, particularly with methadone and opium, aligns with existing literature (19–22), highlighting an increasing trend of opioid exposure among children. Public health interventions are needed to reduce adult substance misuse and decrease pediatric poisonings.
Contrary to traditional views, many poisonings were caregiver-administered, indicating the need for educational programs on safe medication storage and the dangers of using drugs like opium for pediatric ailments.
The significant representation of infants less than six months in the illicit drug group suggests specific regional or cultural practices using narcotics for common infant complaints, requiring community-based educational efforts to change harmful practices.
Limitations: Our study has several limitations. First, its retrospective design limits our ability to determine the causality between substance exposure and health outcomes, and reliance on medical records introduces potential information bias. Second, using data from a single hospital may cause selection bias, limiting the generalizability to other pediatric populations in different geographical or socioeconomic settings. Third, reporting bias is a concern, as many diagnoses relied on guardian reports and clinical observations without consistent toxicological confirmation, potentially leading to underreporting or misclassification. Excluding cases with more than 10% missing data might also introduce bias if the missing is not random. Additionally, negative urine toxicology tests highlight potential test sensitivity or timing issues, affecting diagnostic accuracy. Lastly, the absence of longitudinal follow-up prevents us from assessing the long-term health impacts of pediatric poisoning, limiting our insights to immediate clinical presentations and outcomes.
Recommendations: To address the high admission rates of children due to poisoning and the need for follow-up of high-risk cases, we suggest implementing a data registration system at this referral hospital to track long-term outcomes and inform prevention and education strategies to reduce pediatric mortality and morbidity. Additionally, methadone poisoning should be considered a primary differential diagnosis when illicit drug use is suspected, and the patient’s glucose levels are high.
Conclusion
In general, children poisoned with illicit drugs had worse conditions in terms of vital and laboratory signs compared to other causes of poisoning, and responsible organizations must support these children. In this study, there was a statistically significant difference between the blood sugar of methadone poisoning compared to other drugs. It is suggested that methadone poisoning should be placed at the top of the diagnosis in cases of children suspected of poisoning with illicit drugs and high blood sugar.
Author contributions
L.B contributed to the conceptualization, methodology, data curation, investigation, project administration, supervision, and writing and editing the manuscript. O.M contributed to the conceptualization, methodology, investigation, and writing and editing the manuscript. M.V contributed to data analysis, supervision, writing and editing the manuscript. M.T contributed to conceptualization, methodology, data curation, investigation, project administration, supervision, and writing and editing the manuscript. All authors read and verified the final version of the manuscript.
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author, Mehrdad Teimoorian, at Golestan University of Medical Sciences, on reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
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References
- 1.Alinejad, S., Chahkandi, T., Mehrpour, O., Brent, J. & Riahi, S. M. Epidemiology of pediatric acute poisoning in Iran: a systematic review and meta-analysis. Int. J. Pediatr. (2022).
- 2.Dai, Q. et al. Clinical and epidemiological characteristics of acute poisoning in children in southwestern China: a review of 1755 cases from 2014 to 2020. Int. J. Gen. Med.15, 133 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Gheshlaghi, F., Piri-Ardakani, M. R., Yaraghi, M., Shafiei, F. & Behjati, M. Acute poisoning in children; a population study in Isfahan, Iran, 2008–2010. Iran. J. Pediatr.23 (2), 189 (2013). [PMC free article] [PubMed] [Google Scholar]
- 4.Cheraghali, F. & Teymouri, M. Epidemiological study of drug intoxication in children. Acta Med. Iranica. 44 (1), 37–40 (2006). [Google Scholar]
- 5.Graham, J., Leonard, J., Banerji, S. & Wang, G. S. Illicit drug exposures in young pediatric patients reported to the national poison Data System, 2006–2016. J. Pediatr.219, 254–258 (2020). [DOI] [PubMed] [Google Scholar]
- 6.Noori, N. M., Boryri, T., Shahri, E. S., Teimouri, A. & Moghadam, S. S. Clinical and socioeconomic factors associating with opium poisonings in children and adolescents.
- 7.Momayyezi, M., Peigan, P. & Fallahzadeh, H. Epidemiological pattern of poisoning in children under the age of 15 admitted to the referral teaching hospitals of Yazd and Taft cities (2014–2019). J. Environ. Health Sustainable Dev. Sep 25. (2021).
- 8.Mohammadi, N., Rastgoo, N. & Zadeh, S. E. Epidemiological and clinical features of Acute Poisoning in Children in a Referral Teaching Hospital in Iran, 2015–2018. J. Compr. Pediatr. ;11(4). (2020).
- 9.Ghaffourian, T., Barati, L., Khajavi, A. & Mehrjerdian, M. Evaluation of Methadone Poisoning in Pediatric Emergency Department, Gorgan, North of Iran (2011-19). J. Gorgan Univ. Med. Sci.23 (4), 95–98 (2022). [Google Scholar]
- 10.Manouchehrifar, M., Derakhshandeh, N., Shojaee, M., Sabzghabaei, A. & Farnaghi, F. An epidemiologic study of pediatric poisoning; a six-month cross-sectional study. Emergency. 4 (1), 21 (2016). [PMC free article] [PubMed] [Google Scholar]
- 11.Haratipour, H., Yahyaei, B. & Jahanpour, H. Determination of pediatric poisoning factors in children. J. Gorgan Univ. Med. Sci.18 (2), 127–131 (2016). [Google Scholar]
- 12.Besharat, S., Jabbari, A. & Besharat, M. Opium as a fatal substance. Indian J. Pediatr.75, 1125–1128 (2008). [DOI] [PubMed] [Google Scholar]
- 13.Oliveira, F. F. & Suchara, E. A. Epidemiological profile of exogenous poisoning in children and adolescents from a municipality in the state of Mato Grosso. Revista Paulista De Pediatria. 32, 299–305 (2014). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Lee, J. et al. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr. Neonatology. 60 (1), 59–67 (2019). [DOI] [PubMed] [Google Scholar]
- 15.Hemmati, M. et al. Poisoning in children and adolescents in Kermanshah city, Iran. [DOI] [PMC free article] [PubMed]
- 16.Nasiri, E., Talebi, P., Mahmoudpour, Q. & Rezaei Orimi, J. Epidemiology study on poisoning in Patients.Received Pre-hospital Emergency Services in Ghaemshahr, Iran. J. Guilan Univ. Med. Sci.30 (1), 28–39 (2021). [Google Scholar]
- 17.Mehrpour, O., Sharifi, M. & Ebrahimi, M. Pattern of acute pediatric poisonings in Birjand city, East of Iran. Int. J. Med. Toxic. Forensic Medic. 5 (4-autumn), 192–200 (2015). [Google Scholar]
- 18.Feiz Disfani, H. et al. Risk factors contributing to the incidence and mortality of acute childhood poisoning in emergency department patients in Iran: a hospital-based case-control study. Epidemiol. Health ; 41. (2019). [DOI] [PMC free article] [PubMed]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author, Mehrdad Teimoorian, at Golestan University of Medical Sciences, on reasonable request.