Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparative study of two types of fluid therapy with dextrose saline serum (DS) and one-third two-thirds serum (1.3, 2.3) in patients with acute opioids poisoning in terms of outcome and length of hospitalization

Document Type : Original Article(s)

Authors
Shiva Samsamshariat 1
غلامعلی Dorooshi 2
Maryam Shakiba 3
Nastaran Eizadi-Mood 4
1 Assistant Professor, Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v43.i845.1816
Abstract
Background: Opioid poisoning is the most common case of hospitalization in the emergency room of poisoned patients. Administering fluid therapy with appropriate serum with the aim of establishing tissue perfusion and electrolyte stability is a crucial step in the therapeutic management of these patients.
Methods: This study is cross-sectional and descriptive-analytical. The target population is all patients aged 15 to 64 years with opioid poisoning admitted to the poisoning ward of Khurshid Hospital, Isfahan in 2020-2021. The prepared checklist including demographic variables, vital signs, paraclinical test results and complications, and clinical outcome completed and the study results analyzed.
Findings: 169 patients poisoned with various opioid, including 73.3% men, were included in the study. The mean age of the patients was 35+_13 years. A significant relationship observed between the treatment outcome, the type of opioid used, DBP, RR on admission and at 24 hours of hospitalization, and CPK on admission, with the type of fluid therapy. No significant relationship was observed between other variables including the first dose of naloxone required, the interval between opioid use and hospital admission, the length of hospital stay, and most tests and vital signs with the type of fluid therapy.
Conclusion: No significant difference was identified between treatment outcome, length of hospital stays, vital signs, and laboratory tests in fluid therapy with the serums studied in this study. The selection of maintenance therapy with available fluids should be based on the individual needs of patients and clinical conditions.

Highlights

Shiva Samsamshariat: Google Scholar, PubMed

Gholamali Dorooshi :Google Scholar, PubMed

Nastaran Eizadi-Mood : Google Scholar, PubMed

Keywords
Fluid therapy
Poisoning
Outcome
Opioid

Subjects

1.     Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent JL, Yates D, Kellum JA, Mythen MG, Shaw AD; ADQI XII Investigators Group. Four phases of intravenous fluid therapy: a conceptual model. Br J Anaesth 2014; 113(5): 740-7.
2.     Eastwood GM, Peck L, Young H, Prowle J, Vasudevan V, Jones D, Bellomo R. Intravenous fluid administration and monitoring for adult ward patients in a teaching hospital. Nurs Health Sci 2012; 14(2): 265-71.
3.     Ablij HC, Innemee G, Tamsma JT, Meinders AE. Intravenous fluid therapy taken into theoretical and practical consideration: physiology revisited. Neth J Med 2001; 58(3): 111-22.
4.     Boer C, Bossers SM, Koning NJ. Choice of fluid type: physiological concepts and perioperative indications. Br J Anaesth 2018; 120(2): 384-96.
5.     Baumgarten M, Brødsgaard A, Bunkenborg G, Nørholm V, Foss NB. Nurses' Indications for Administration of Perioperative Intravenous Fluid Therapy-A Prospective, Descriptive, Single-Center Cohort Study. J Perianesth Nurs 2019; 34(4): 717-28.
6.     Raghunathan K, Shaw A, Nathanson B, Stürmer T, Brookhart A, Stefan MS, Setoguchi S, Beadles C, Lindenauer PK. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*. Crit Care Med 2014; 42(7): 1585-91.
7.     Finfer S, Myburgh J, Bellomo R. Intravenous fluid therapy in critically ill adults. Nat Rev Nephrol 2018; 14(9): 541-57.
8.     Hammond NE, Taylor C, Finfer S, Machado FR, An Y, Billot L, et al. Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study. PLoS One 2017; 12(5): e0176292.
9.     Blumberg N, Cholette JM, Pietropaoli AP, Phipps R, Spinelli SL, Eaton MP, Noronha SA, Seghatchian J, Heal JM, Refaai MA. 0.9% NaCl (Normal Saline) - Perhaps not so normal after all? Transfus Apher Sci 2018; 57(1): 127-31.
10.  Najib Pour N, Talaii Zadeh A, Tajali H. Comparison between the Effect of Hypertonic Saline and Ringer Lactate in Resuscitation of Trauma Patients with Hypovolemic Shock [in persian]. Jundishapur Scientific Medical Journal 2016; 15(4): 391-6.
11.  Ekbal NJ, Hennis P, Dyson A, Mythen M, James MFM, Singer M. The anion study: effect of different crystalloid solutions on acid base balance, physiology, and survival in a rodent model of acute isovolaemic haemodilution. Br J Anaesth 2018; 120(6): 1412-9.
12.  Kow CS, Burud IAS, Hasan SS. Fluid Resuscitation With Lactated Ringer's Solution Versus Normal Saline in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials. Pancreas 2022; 51(7): 752-5.
13.  Bhat N, Balliu E, Osipoff J, Lane A, Wilson T. Opioid-induced hyponatremia in a patient with central diabetes insipidus: independence from ADH. J Pediatr Endocrinol Metab 2017; 30(6): 693-6.
14.  Dolinak D. Opioid Toxicity. Acad Forensic Pathol. 2017;7(1):19-35.
15.  Carroll Turpin MA, Starks SM, Grissom MO, Reed BC. Addiction Medicine: Opioid Use Disorder. FP Essent. 2024; 546: 29-36.
16.  Zibbell J, Howard J, Clarke SD, Ferrell A, Karon S. Non-fatal opioid overdose and associated health outcomes: Final summary report. US Department of Health and Human Services. [2019] Available from: https://aspe.hhs.gov/reports/non-fatal-opioid-overdose-associated-health-outcomes-final-summary-report.
17.  Farkas A, Lynch MJ, Westover R, Giles J, Siripong N, Nalatwad A, et al. Pulmonary Complications of Opioid Overdose Treated with Naloxone. Ann Emerg Med 2020; 75(1): 39-48.
18.  Doshi R, Majmundar M, Kansara T, Desai R, Shah J, Kumar A, et al. Frequency of Cardiovascular Events and In-hospital Mortality with Opioid Overdose Hospitalizations. The American Journal of Cardiology. 2019;124(10):1528-33.
19.  Saari TI, Strang J, Dale O. Clinical Pharmacokinetics and Pharmacodynamics of Naloxone. Clin Pharmacokinet 2024; 63(4): 397-422
20.  Parthvi R, Agrawal A, Khanijo S, Tsegaye A, Talwar A. Acute opiate overdose: an update on management strategies in emergency department and critical care unit. Am J Ther 2019; 26(3): e380-e387.
21.  Pettrone K, Curtin SC. Urban-rural Differences in Suicide Rates, by Sex and Three Leading Methods: United States, 2000-2018. NCHS Data Brief 2020; (373): 1-8.
22.  Jayakrishnan B, Al Asmi A, Al Qassabi A, Nandhagopal R, Mohammed I. Acute drug overdose: clinical profile, etiologic spectrum and determinants of duration of intensive medical treatment. Oman Med J 2012; 27(6): 501-4.
23.  Moslem S, Soheila K, Akvan P, Parisa M, Rozina Abasi L, Leila M. Effect of Isotonic and Hypotonic Fluid Therapy on Serum Sodium: A Randomized Controlled Trial. Acta Medica Iranica 2020; 58(8).
24.  Rismantab-Sani S, Soltani B, Soltani S, Memarian A. Risk Factors of Mortality Due to Acute Opium Poisoning: A Report from the Largest Intoxication Referral Center in Iran. Addict Health 2017; 9(2): 96-102.
25.  van Regenmortel N, De Weerdt T, van Craenenbroeck AH, Roelant E, Verbrugghe W, Dams K, et al. Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers. Br J Anaesth 2017; 118(6): 892-900.
Journal of Isfahan Medical School
Volume 43, Issue 845
1st Week, March
March and April 2026
Pages 1816-1822

  • Receive Date 28 May 2024
  • Accept Date 25 October 2025