Clinical profile of designer drug “Strox” intoxicated cases presented to Poison control center Ain Shams University, Egypt from first of January 2017 to end of January 2018

Introduction: Drug addiction is considered one of the serious problems. Clinical profile of drug dependence is continuously changing taking new shape, new drugs and routes. From 2004, illicit drug manufacturers began to produce herbal smoking substances under a wide range of brand names. Recently over the past two to three years, the drug abuse market in Egypt was invaded by a new herbal preparation, called “Strox” that gained favor among abusers and rapidly spread. Aim of Study: to evaluate the strox toxicity cases including; the presenting symptoms and signs, the lines of treatment and highlight the outcomes secondary to strox exposure, also correlate the presenting clinical pictures with strox structure. Methodology: A cross sectional observational study carried out at Poison Control Center Ain Shams University (PCC-ASU). The study included all strox intoxicated patients presented to PCC-ASU from the first of Jan. 2017 to the end of Jan. 2018, and the obtained seized Strox packages screened by Gas Chromatography (GC). Results: there were 84 patients. The mean age was 25±9.8 year. The median of delay time was 2-4 hours. Disturbed conscious level observed in 45% of patients, chest pain (37%), shortness of breathing (32%). Hypoxemia was evident in 65% of cases, associated with Hypercapnia and respiratory acidosis in 50 % of cases. No observed changes regarding serum electrolytes, renal function or random blood sugar. ST segment depression and T wave inversion were reported in 6% of cases. All patients were admitted and received supportive treatment. Gas chromatographic analysis of some Strox packages revealed the presence of xylene, methylene dioxy methamphetamine, and trihexyphenidyl. Conclusion: Patients with Strox smoking presented with transient coma, hallucinations, impaired ventilation, and chest pain. The displayed picture was attributed to a mixture of xylene, MDMA, and the central anti-cholinergic trihexiphenidyl. The picture was confirmed by gas chromatography analysis of seized strox package.