Toxicology

1. Poison Control and Toxicology Information Services in Saudi Arabia:

1.a. National Drug and Poison Information Center (NDPIC):

• Operated by the Saudi Food and Drug Authority (SFDA), the National Drug and Poison Information Center (NDPIC) provides:

• Immediate expert guidance on drug and poisoning management for healthcare professionals and the public.

• Evidence-based toxicology information and consultation.

• Public education and awareness on toxic risks.

• Contact:

• Website: dpic.sfda.gov.sa

• Phone: 19999

• Email: ndpic@sfda.gov.sa

• The NDPIC responds to poison inquiries and supports clinical decision-making; currently operating primarily during business hours with plans to expand to 24/7 services.  

1.b. Ministry of Health Poison Control Services:

• The Ministry of Health (MOH) operates poison control programs, including the “937” call center, which registers and responds to poisoning exposures reported by the public and healthcare facilities.

• Poison control consultants provide recommendations for triage, observation at home, and need for hospital evaluation.  

1.c. Academic/Research Centers:

• Center for Toxicology Research and Studies (Madinah): affiliated with Taibah University, focusing on research, training, and community toxicology risk assessment.  

d. Clinical Toxicology Consultation Services:

• Digital teleconsultation models like the Toxicology Consultation Service (TCS) linked with the Saudi Medical Appointments and Referrals Center (SMARC) allow treating hospitals to obtain specialist toxicology advice for acute poisoning cases.  

2. Epidemiology: Common Overdoses and Poisoning Patterns

2.a. General Patterns:

• Drugs are the most common cause of poisoning exposures reported to Saudi poison centers, followed by household chemicals.  

• Most reported poisonings are accidental and occur via the oral route.  

2.b. Age and Demographics:

• Children, especially under age 6, represent a large majority (often >80%) of reported poisoning exposures.  

2.c. Common Agents (Saudi Data):

Based on toxicology center registries and retrospective studies:

• Medications:

• Analgesics (notably acetaminophen/paracetamol)

• NSAIDs

• Antihistamines

• Antibiotics, antiepileptics, cardiovascular drugs

• Household Chemicals: cleaning agents, solvents, disinfectants, pesticides

• Alcohol and sanitizers

• Rodenticides and insecticides (less common but present)  

Note: Cohort studies specifically quantifying opioids or illicit drug overdoses in national Saudi datasets are limited in the published literature to date; local patterns may differ from North American overdose epidemics.

2.d. Foodborne Poisoning

• Outbreaks of food poisoning clusters are also reported; central region (e.g., Riyadh) often has high numbers of cases, especially in summer outbreaks.  

3. Antidotes Commonly Used in Saudi Practice

While Saudi poison exposure patterns vary, common antidotes in clinical toxicology practice include:

Medication/Poison Exposure → Antidote

• Acetaminophen overdose → N-acetylcysteine (NAC)

• Opioid toxicity → Naloxone

• Organophosphate/pesticide poisoning → Atropine + pralidoxime

• Beta-blocker or calcium channel blocker overdose → high-dose insulin/glucose protocols

• Methanol/ethylene glycol → Fomepizole or ethanol (depending on availability)

• Benzodiazepine overdose → Flumazenil (carefully, with contraindications)

• Cyanide exposure → hydroxocobalamin or other cyanide antidote kits

These are consistent with standard toxicology practice; local hospital formularies dictate availability.

4. Venomous Insects and Animals in Saudi Arabia:

Saudi Arabia’s fauna includes several medically relevant venomous species:

4.a. Scorpions

• Several species (e.g., Leiurus quinquestriatus, Androctonus spp.) are found across the Kingdom and are among the most common causes of envenomation. Scorpion stings can cause local pain, autonomic instability, and severe systemic symptoms in children.

4.b. Snakes

• A number of venomous snakes inhabit the Arabian Peninsula (e.g., saw-scaled viper), capable of causing coagulopathy and systemic neurotoxicity in envenoming.

4.c. Spiders and Insects

• Less common but present are spiders with medically significant bites and hymenopterans (bees, wasps) causing allergic reactions or anaphylaxis.

Management:

Treatment of venomous bites/stings includes supportive care, pain control, and antivenoms when indicated per local protocols; availability of specific antivenoms and regional guidelines varies.

5. Toxicologists and Their Role in Saudi Healthcare

5.a. Clinical Toxicologists

• Physicians with specialized training (often emergency medicine or internal medicine with a toxicology fellowship) provide:

  • Consultation on poisoning cases

  • Antidote selection and dosing

  • Poisoning risk assessment

  • Toxicokinetic interpretation

  • Education and guideline development

5.b. Poison Information Specialists

• Pharmacists and specialists staffed at NDPIC and poison centers who provide real-time poison management guidance.

5.c. Academic and Research Contribution

• Universities and research centers contribute through toxicology education, research, and surveillance of poisoning trends, training future toxicologists and engaging in community outreach.  

6. Deaths from Overdose and Poisoning in Saudi Arabia

National quantitative mortality data specifically attributed to drug overdoses (e.g., opioids) in Saudi Arabia is not robustly published in the same systematic way as in some other countries; however:

• Children’s poisoning cases can result in fatalities when exposures are significant; pediatric poisoning mortality has been documented in review data.  

• Older forensic studies suggest that poisoning and toxic substance deaths (e.g., pesticides, carbon monoxide) contribute to a portion of injury-related deaths in regional studies, though not at rates comparable to major overdose epidemics elsewhere.  

Comprehensive national mortality statistics require linkage of toxicology registries with Saudi national vital statistics; such integrated reports are limited in the peer-reviewed literature at present.

7. Prevention and Reporting

• Public health initiatives include poisoning awareness campaigns, home safety guidance, and reporting mechanisms through MOH guidelines for chemical and drug poisoning reporting to improve surveillance and response.  

*Key References*

• Saudi Food & Drug Authority – National Drug & Poison Information Center overview.  

• Ministry of Health poison control consultations and poison reporting.  

• Toxicology teleconsultation study outlining poisoning epidemiology in Saudi hospitals.  

• Center for Toxicology Research and Studies (academic toxicology).  

• Pediatric poisoning mortality patterns in the Kingdom.