Electrocardiographic Changes in Children with Opioid Poisoning Referred to Vali-e-Asr Hospital, Birjand, Iran during 2015 to 2017

Background and Objective: Opioid poisoning in children is a common pediatric emergency in Iran. In recent years, the pattern of opium abuse has been changed and new more dangerous synthetic compounds (e.g. methadone) have been introduced. This trend has come up with new presentations and consequences in case of toxicity which are not well known. There are some reports about opioids affecting cardiovascular systems. In this study we aimed to evaluate Electrocardiographic changes in children with acute opioid poisoning Referred to Vali-e-Asr Hospital, Birjand, Iran during 2015 to 2017. Materials and Methods: In this analytical cross sectional study all children under the age of 12 with opioid poisoning, who were referred to Vali-e-Asr Hospital, Birjand, Iran from December 2015 to February 2017, were enrolled. The inclusion criteria were the diagnosis of opioid poisoning and willingness to participate in the study. Children with congenital heart diseases or liver disorders, children taking drugs affecting ECG and those suffering electrolyte disturbances were excluded from this study. The study protocol had been previously confirmed by the Ethics Committee of Birjand University of Medical Sciences (ir.bums.rec.1394.344). Data was collected using a pre-designed checklist. From all patients, an electrocardiograph (ECG) was obtained and reviewed by two pediatric cardiologists for changes and abnormalities. Data were analyzed using SPSS version 21 with the help of Mann-whitney and Squared Chi tests. P<0.05 was considered statistically significant. Findings: A total of 85 children were enrolled in this study. Most of them were males (51.8%). The mean ± SD of age of patients was 3.46±3.36 years. Winter was the most common season of admission (30.6%). The majority of children’s fathers and mothers had an under-diploma education degree (97.6% and 96.5%, respectively). Among patients, 33 (38.8%) were poisoned with methadone and 52 (61.2%) with opium or other opioids. The most common clinical manifestations were vomiting and cyanosis (47.1% and 25.9%, respectively). The mean QTC was 402.22±49.01 milliseconds in males and 4.01±76.47 milliseconds in females (P Value = 0.9). In non-synthetic and synthetic (methadone) opioid poisoning, the mean QTC was 399.24±12.38 and 406.66±69.34 milliseconds, respectively (P Value=0.2). No ECG abnormalities were detected in patients except for one case (1.2%) with U wave and three cases (3.5%) with long QTC (more than 450 milliseconds) and all these cases were among those poisoned with synthetic opioids. The difference between cases and controls regarding the presence of ECG changes was not statistically significant (P Value=0.06). Conclusion: ECG changes due to acute opioids toxicity in children were not significant, although in case of methadone poisoning long QTC and associated arrhythmias should be anticipated. However, it is still important to be prepared for other life-threatening presentations of opioid toxicity (e.g. respiratory insufficiency).

Keywords:

Electrocardiography , Opium , toxicity , Child