الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hypertension (HTN) is considered one of the most common and challenging chronic health problem worldwide with a prevalence of 1.28 billion cases, most of whom are in developing and underdeveloped countries according to the WHO 2021.
In Egypt, although the real numbers of antihypertensive agents’ toxicity are unknown, 2.6% of the admitted cases to Alexandria Poison Center (APC), in 2020, were due to antihypertensive drugs toxicity.
The aim of this study was to determine the prevalence of acute poisoning with antihypertensive agents among the admitted cases to Alexandria Poison Center (APC), establish a guideline for acute poisoning with antihypertensive agents and study the possible therapeutic role of Methylene Blue (MB) in the refractory cases with beta- blockers (BB) and calcium channel blockers (CCB) toxicity. The study was conducted on patients admitted from 1st of January 2022 till 31st of December 2022.
The study was conducted on 105 patients admitted to Alexandria Poison Center of Alexandria Main University Hospital. After obtaining informed consent from all patients, the patients or their legal guardians were interviewed with thorough history taking, clinical assessment and management. Poison Severity Score (PSS) was employed for determination of severity in both adults and children.
The results of the study showed that:
• Female patients included were 77.1% of the cases.
• Two thirds (66.7%) of the patients were in the age group (18 -65 years).
• The majority of the cases admitted were from urban areas.
• Most of the cases were admitted in June.
• Past history of the patients showed that 20% of the studied cases had cardiovascular disorders.
• Drug Overdose were mostly by Beta Blockers alone or mixed with other drugs, followed by Calcium Channel Blockers.
• 26% of the cases were presented with co-ingested drugs other than antihypertensive drugs.
• A delay between intake and admission was found to be mostly between 2-6 hours in most of the cases.
• Suicidal cases (83.8 %) outnumber accidental cases.
• A significant relation between the age and the circumstances of poisoning where MCp is (<0.001). Accidental poisoning was the commonest among infants and children (94.1%) while suicidal ingestion was the commonest among adolescents (18.2%), adults (74.8%) and elderly (1.1%).
• A significant relation was found between sex and the circumstances of poisoning where FEp <0.001.
• In the current work, the mean systolic BP of the admitted cases was 108.86 ± 22.78 and the mean diastolic BP was 68.70 ± 16.0.
• Regarding the respiratory rate, more than three fourth of the studied cases (84.8%) had normal respiratory rate on admission, while only 16 cases (15.2%) were tachypneic. In the current study, the mean respiratory rate was 22.01±6.71.
• It was found that the highest percentage of the studied cases (84.8%) were presented with normal sinus rhythm. On the other hand, (8.6%) and (6.7%) of the cases presented with bradycardia and tachycardia, respectively.
• Regarding the QTC interval, the majority of the cases (88.6%) had a normal QTC interval while (11.4%) had an abnormally prolonged QTC interval.
• The PR interval and QRS complex were abnormally prolonged among (9.5%) and (1.9%) of the studied cases, respectively.
• The poisoning severity score grades were normal among the vast majority of the cases (65.7%). On the other hand, cases presented with minor and moderate grades were (22.9%) and (8.6%) respectively. Severe and fatal poisoning were detected among 1% and 1.9%, respectively.
• The Glasgow coma scale (GCS) was used to assess the level of consciousness in all studied participants. The score was mild among (96.2%) and moderate in only (3.8%) of the cases. In the current work, the mean GCS score was 14.79 ±0.97.
• Regarding the ABG analysis, more than half of the cases (58.1%) had normal ABG. Metabolic acidosis was seen in (3.8%) and compensated metabolic acidosis in (27.6%) of the cases. Meanwhile respiratory disturbance in the form of respiratory alkalosis in 4.8% and respiratory acidosis in 2.9% of the cases. On the other hand, only (2.9%) had mixed respiratory and metabolic acidosis.
• 18.1% of the cases had some abnormalities in their laboratory results. Elevated cardiac enzymes were recorded in (5.7%) of the admitted cases, hypokalemia, hyponatremia, and hyperkalemia were (4.8%), (4.8%) and (1.9%) of the cases, respectively. 6.7% showed hyperglycemia and only (2.9%) were hypoglycemic.
• Abnormally elevated liver enzymes (AST and\or ALT) was detected in (3.8%) of the cases and high creatinine level was detected in (2.9%) of the cases.
• Neutrophil to lymphocyte ratio was calculated based on neutrophil and lymphocyte counts. It is found that (60%) of the cases had normal NLR ratio, while 4.8% had abnormal law ratio less than 0.7 and (35.2%) had abnormal high ratio more than 3.
• The study revealed that 5.7% of the cases needed ICU admission, with 1.9% of cases died while 98.1% improved.
• Length of the hospital stay varied among the cases, where 63.8% stayed for >1-2 days. While 30.5% stayed >2-4 days followed by less than 1 day 3.8%. However, only 1.9% of the cases stayed for more than 4 days.
• Patients’ admissions due to diuretics and sympatholytic drugs overdose were generally with mild intoxication and tend to improve without mortality