Electrocardiographic Changes in Children With Acute Opioid Poisoning: A Cross-Sectional Study
Hamidreza Riasi1, Navid Rabiee, Tayebeh Chahkandi
1From the Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
Insights
Electrocardiogram (ECG) changes are uncommon in pediatric opioid poisoning, but methadone cases may show prolonged QT intervals and arrhythmias. Healthcare providers should prepare for severe opioid toxicity effects in children.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Toxicology
- Cardiology
Background:
- Opioid poisoning is a significant pediatric emergency in Iran.
- Emerging synthetic opioids present new toxicity challenges.
- Understanding electrocardiographic (ECG) effects in pediatric opioid poisoning is crucial.
Purpose of the Study:
- To evaluate electrocardiographic (ECG) changes in children experiencing acute opioid poisoning.
- To identify specific ECG alterations associated with different types of opioids.
Main Methods:
- Cross-sectional study of children with opioid poisoning at Vali-e-Asr Hospital, Iran (December 2015 - February 2017).
- Data collection included demographics, clinical presentation, and outcomes.
- Electrocardiograms (ECGs) were analyzed for arrhythmias and corrected QT interval (QTc).
Main Results:
- 85 children were included; 38.8% were poisoned by synthetic opioids (methadone).
- Mean QTc was 399 ms for non-synthetic and 407 ms for methadone poisoning.
- Prolonged QTc (>450 ms) occurred in 3.5%; U wave formation in 1.2% (methadone case).
Conclusions:
- ECG changes are infrequent in pediatric opioid toxicity.
- Methadone poisoning warrants anticipation of prolonged QT interval and arrhythmias.
- Preparedness for severe opioid effects like respiratory insufficiency is essential.
Objectives:
Opioid poisoning in children is a common pediatric emergency in Iran. The emergence and spread of new synthetic opioids have come up with new consequences in case of toxicity. In this study, we aimed to evaluate electrocardiographic changes in children with acute opiate poisoning.
Methods:
This cross-sectional study was performed on all children with opioid poisoning admitted to the emergency ward of Vali-e-Asr Hospital, Birjand, Iran, from December 2015 to February 2017. Data (demographics, manifestations, clinical course, and outcome) were collected using a predesigned checklist. An electrocardiogram (ECG) was obtained and evaluated for arrhythmias, corrected QT interval (QTc), and other ECG indices. Data were analyzed using SPSS version 21. A value of P less than 0.05 was considered statistically significant.
Results:
A total of 85 children were enrolled in this study. Most of them were male (51.8%). The mean age of the patients was 3.46 ± 3.36 years. Among these children, 38.8% were poisoned with synthetic opioids (methadone). Mean QTc length was 399 ± 24 milliseconds in nonsynthetic opioid poisoning and 407 ± 66 milliseconds in methadone poisoning, and it was prolonged (>450 milliseconds) in 3.5% of cases. Other ECG changes were limited to 1 U wave formation (1.2%) that was detected in a patient with methadone poisoning.
Conclusions:
Electrocardiogram changes due to acute opioid toxicity in children are not common, although in the case of methadone poisoning, long QT interval and associated arrhythmias should be anticipated. Moreover, because of life-threatening effects of opioids such as respiratory insufficiency and decreased consciousness, it is necessary to be prepared for these conditions.
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