A profile of acute poisoning at Mangalore (South India)

Clinical and Epidemiological Study of Poisoning Cases Presenting to the Emergency Department of a Tertiary Care Center in Central India

Objective To analyze the clinical and epidemiological characteristics of acute cases of poisoning and the pre-hospital measures that the patient receives before seeking care in an emergency department at a tertiary care center in Central India. Methods An observational prospective study was carried out over 18 months, and the relevant findings were documented using a predesigned data collection form. All patients who presented to the emergency department and were 18 years of age or older were recruited, and consent was sought. Data analysis was performed using the SPSS software. Results A total of 102 patients diagnosed with poisoning were taken for this study, and data were collected and analyzed. The mean age was 32.8 ± 13.75 years. Of the study population, 63 (61.8%) patients were males. In our study, the most common cause of poisoning was impulsive intake of poison (n = 22, 21.5%) and suicidal ingestion in patients with depression (n = 18, 17.6%). In the emergency department, 61 patients (59.8%) received gastric lavage, and 37 patients (36.3%) received an antidote. The most common agent of poisoning was pesticide ingestion, accounting for 45 (44%) of the total cases. Prescribed drugs were the second-largest group (n = 19, 18.6%). Other common poisoning agents were rodenticides (n = 12, 11.7%), corrosives (n = 8, 7.8%), and aluminum phosphide (n = 3, 2.9%). Out of 102 patients, 82 patients survived, 15 patients died, and five patients left against medical advice (LAMA). One patient had residual comorbidity and was discharged with jejunostomy. The maximum mortality (22.5%) was due to organophosphorus compounds. Conclusions While accidental encounters are also common, intentional self-harm accounts for the majority of poisonings; homicidal motives are less likely. Pesticides were the most often used poisoning agents, followed by prescribed and over-the-counter drugs, rodenticides, corrosive agents, and aluminum phosphide. Of the poisoned cases, 69.6% had a full recovery, 22.54% of them died, and eight (7.84%) among them left against medical advice (LAMA). Organophosphorus chemicals were the cause of the highest mortality (22.5%).

Clinico-Epidemiological Profile and Short-Term Outcomes of Patients with Acute Poisoning Presenting to an Emergency of a Tertiary Care Center in Western Rajasthan

Background

This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital.

Materials and Methods

This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes.

Results

Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning.

Conclusions

This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.

Investigation of acute organophosphate poisoning in humans based on sociodemographic and role of neurotransmitters with survival study in South India

The aim of this study was to investigate the sociodemographic characteristics of patients based on the poison chosen and different types of organophosphorus compounds. The data were collected to explore the sociodemographic characteristics of organophosphate (OP)-poisoned patients based on the source, site, and route of poisoning, education level, occupational status, and the purpose of poisoning. Furthermore, we estimated the serotonin and dopamine levels in the plasma samples of patients, and survival plots were also described. During the study of OP pesticide poisoning in 116 human subjects and 5 healthy volunteers, we observed, based on the survival plot, that75.9% of the patients were discharged, and the remaining patients died (24.1% of the patients) due to respiratory failure followed by cardiac arrest. Our findings suggest that the serotonin levels significantly (p < 0.01 and p < 0.001) decreased from 12 to 36 h, whereas the dopamine levels slightly increased from 12 to 36 h in the group with OP poisoning compared to the control group. Based on these findings, this study may aid in deciphering the precise mechanism by which pesticides cause behavioural changes that influence serotonin and dopamine levels in OP-poisoned patients. The purpose of this work was to serve as a small reminder of the risk to public health associated with organophosphate pesticides.

Estimation of chlorpyrifos distribution in forensic visceral samples and body fluids using LCMS method

The ingestion of the insecticide chlorpyrifos leads to fatal intoxication in suicidal cases, and its distribution can be assessed only after post-mortem. This study attempted to investigate the distribution of chlorpyrifos in forensic visceral tissue samples like stomach, liver, kidney, heart, brain, lung, spleen, muscle and body fluids like blood and urine by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) with the liquid-liquid extraction method. An analysis time of 8.77 min with 1 μl as an injection volume was chosen. The results obtained are analysed using Labsolutions insight LCMS software, considering Multiple Reaction Monitoring (MRM) and Retention Time (RT). Our findings depict that the stomach tissue has very high concentrations of chlorpyrifos, which suggests the possibility of high distribution and aspiration in the stomach tissue. The concentration of chlorpyrifos in stomach tissue ranged from 816 to 901 μg/g in male cadavers and from 443 to 612 μg/g in female cadavers. Among all the tissues, the stomach tissue showed the highest concentration, while the lowest concentration was found in muscle. Metabolic distribution of chlorpyrifos from the stomach contents to the other surrounding organs may occur and hence the concentrations of CPF were also seen in other organs like the liver, lung, kidney, brain, and muscle. These toxicological results from autopsy findings, together with LC-MS/MS indicate that stomach tissue examination gives an accurate profile of insecticide poisoning in forensic samples with acute poisoning.

The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study

Background and Aims

Poisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran.

Methods

This was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16.

Results

Thirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%).

Conclusion

These findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.

Rodenticide ingestion is an important cause of acute hepatotoxicity in Tamil Nadu, southern India

BACKGROUND AND AIM

Though rodenticidal hepatotoxicity is reported from India, there is no systematic study to assess its magnitude. This study aimed to assess exposure to rodenticide as a risk factor for acute hepatotoxicity in Tamil Nadu, India.

METHODS

We retrospectively analyzed acute hepatotoxicity caused by ingestion of hepatotoxin or potentially hepatotoxic drug overdose across 15 hospitals in 6 districts of Tamil Nadu from 1 January 2019 to 30 June 2019. Study exclusion criteria were idiosyncratic drug-induced liver injury and chronic liver diseases.

RESULTS

Of the 702 patients, 685 gave history of consuming rodenticide; hepatotoxicity in the other patients resulted from paracetamol overdose (n=10) and due to other drugs (n=7); 97% patients had a suicidal intent. Of 671 patients with complete data, ratio of number of patients with hepatotoxicity due to rodenticide to paracetamol overdose was 450:6 (i.e. 75:1). The 451 rodenticidal hepatotoxicity patients (255 males, 75% were 15-34 years old) underwent conservative management (n=396), plasma exchange (n=54) and plasma exchange followed by liver transplant (n=1); 159 patients (35%) had poor outcome (131 died, 28 discharged in moribund state). Based on our observations, we estimate a case burden of 1584 rodenticidal hepatotoxicity patients (95% CI: 265-6119) with poor outcome in 554 patients in Tamil Nadu from January 2019 to June 2019. Population attributable risk for rodenticide as cause of hepatotoxicity was 22.7%.

CONCLUSION

Rodenticide ingestion was an important cause of acute hepatotoxicity in Tamil Nadu. Most patients were young and one-third had poor outcome. Public health interventions are needed to address this.

Importance of pesticides for lethal poisoning in India during 1999 to 2018: a systematic review

BACKGROUND

Poisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years.

METHODS

We performed a systematic literature review in Medline, Embase and Google Scholar (1999-2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study.

RESULTS

We identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999-2003), the number of deaths declining thereafter (to n = 1714 in 2014-2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths.

CONCLUSION

Use of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter's lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions.

Incidence and profile of acute intoxication among adult population in Najran, Saudi Arabia: A retrospective study

Acute poisoning is considered one of the most important medical emergencies, resulting in severe morbidity and mortality, and is an economic burden on governments. This study aimed to determine the extent of acute adult intoxication among the population located in the Najran area, Saudi Arabia, over the last 3 years (from January 2017 to December 2019). The study is a hospital-based retrospective observational study. The data of all acutely intoxicated adult patients were collected from patients' files of King Khalid Hospital, the main hospital in the Najran area. In this study, the total number of intoxicated patients was 852. Patients were divided into three groups according to their age: 15-25 years, 26-35 years and >35 years. Accidental intoxication was predominant (64.6%), especially with therapeutic drugs (60.2%), predominantly acetaminophen and amphetamine, which intoxicated 24.5% and 23.4% of the patients, respectively. Moreover, this study showed that 10.6% of patients were intoxicated with overdoses of alcohol, mostly among patients aged over 35 years. Furthermore, the present study revealed that 23.9% of patients were intoxicated with household chemicals, especially Clorox bleach or Flash. Patients presented with a wide range of symptoms; some were even asymptomatic. Overall, patients' outcomes were good; mortalities were few (1.2%), and most fatalities were found in patients aged over 35 years (60%). The present study showed that pharmaceutical drugs constituted the most common causative agents in acute intoxication. Household chemicals, especially Clorox bleach, Flash and pesticides, are highly implicated in the acute toxicity problem. Drug abuse, especially amphetamine and alcohol, still represents a great threat facing people from the Najran region. It is crucial to deliver effective public health education programmes to increase community awareness about the predisposing risk factors of acute toxicity, whether as overdoses or suicide attempts.

Assessment of the Sociodemographic Profile, Pattern, and Outcomes of Intentional Poisoning Cases in an Emergency Department of a Tertiary Care Teaching Hospital

Background: Intentional self-poisoning has become a major health problem in low- and middle-income countries. Aims: We aimed to assess the sociodemographic profile, pattern, and outcomes of intentional poisoning cases in the emergency department of a tertiary care teaching hospital. Method: A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1 year to study the sociodemographic profile, pattern, and outcomes of intentional poisoning cases. Results: The majority of poisonings were observed in the male population (64.5%) and among the age group of 19-40 years (65.2%). Poisoning was prevalent in rural/semi-urban populations (77.5%) and in people engaged in agriculture (28.4%) for their livelihood. Pesticides were the most common agents implicated (65.9%) in poisonings. Based on the Glasgow Coma Scale (GCS) and Poison Severity Scale (PSS), the majority of people with poisoning presented with mild (53.9%) and minor symptoms (36.3%). In 78.5% of the cases, patients recovered while mortality was observed in 5.4% of cases. Conclusion: There was a strong association between outcomes of poisoning and age. Organophosphate pesticides were the most commonly implicated substances in poisonings. Regulation policies should be made by the government to regulate the transport, distribution, and use of insecticides and pesticides.

A hospital-based cross-sectional study on suicidal poisoning in Western Uttar Pradesh

BACKGROUND AND AIMS

Poisoning is most common method of committing suicide in India. Objectives of this study to assess prevalence of suicidal poisoning among all poisoning cases, its socio-demographic profile and its reasons in all admitted cases of suicidal poisoning in hospital.

METHODS

A cross-sectional study was conducted on cases of poisoning of any age group admitted in the Chhatrapati Shivaji Subharti Hospital, Meerut. Poisoning cases with history or evidence of suicide were further interviewed. A semi-structured interview schedule in Hindi was used to collect data. Microsoft Excel 365 and R software version 3.6.0 were used for data entry and analysis respectively.

RESULTS

Among total 135 poisoning cases admitted in hospital, 126 provided consent and included in the study. Prevalence of suicidal poisoning was 77.7% (98). Most common age group involved was 11-20 years (36.7%) and 21-30 years (35.7%) and most of the participants were males (59.2%). Most suicidal poisoning cases took Aluminum Phosphide (31.6%), followed by Organophosphates (20.4%) as poison. Most frequent reasons for suicide as described by participants were 'Family quarrel or family unhappiness' (29.6%), 'failure in examination or interview or business' (23.5%), 'ill treatment by spouse or in laws' (16.3%) and 'unemployment' (9.2%).

CONCLUSION

Our study shows that consuming Agriculture poisons (Aluminum Phosphide and Organophosphates) are most common (52%) poisons consumed by suicidal poisoning cases. Agriculture poisons (Aluminum Phosphide and Organophosphates) are easily available in markets in India. There should be some restriction on their purchase to reduce suicidal incidences.

Epidemiologic profile of deaths due to drug and chemical poisoning in patients referred to Baharloo Hospital of Tehran, 2011 to 2014

BACKGROUND

In developing countries with high mortality rates, poisoning is one of the most common causes of admission to emergency rooms. To minimize future deaths related to poisoning, the epidemiological profile of deceased individuals is essential.

METHODS

The medical records of all dead patients due to poisoning during 2011-2014 in Baharloo Hospital, Tehran, were evaluated. Exclusion criteria include: incomplete records, unknown causes of death, and persons less than 6 years of age. Data analysis was done by means of SPSS at the significance level of P < 0.05.

RESULTS

The study included 184 males and 65 females. The mean age range was 37.65 ± 16.78 years. The highest mortality rate was seen in the age range of 21-30 years (30.5%). The most common cause of poisoning was aluminum phosphide (101 cases). The average time of hospitalization was 3.61 days. Most deaths occurred during the first 10 days of admission with intentional poisoning being the most common type (81.5%).

CONCLUSION

The outcome of this study indicates that the main cause of death among young people is intentional poisoning with AIP. This study proves that a greater focus when diagnosing mental health patients, as well as an increase in restrictions when accessing lethal drugs and toxins, is crucial.

Assessment of pattern and outcomes of pesticides poisoning in a tertiary care hospital

OBJECTIVES

To assess the socio-demographic profile, pattern and treatment outcomes of pesticides poisoning.

METHODS

A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1.5 years to study the pattern and outcomes of poisoning cases due to pesticides. Level of significance (P) <0.05 was considered as statistically significant.

RESULTS

A total of 375 poisoning victims with intentional/accidental exposure to pesticides were followed up and documented. The male-female ratio was 1:0.32; mean age was 31.65 ± 13.10 years. 72% of cases were rural residents. Organophosphorus compounds were the most implicated pesticides. Mean Glasgow Comatose Score (GCS) of the patients was 12.22 ± 3.86. 80.3% of patients recovered while 6.4% died. About 13.3% patients were lost to follow-up as they were discharged against medical advice (DAMA).

CONCLUSION

There was a statistical significance seen in the implication of pesticides for intentional poisoning with age, route of administration, area of residence and occupation of the victims. However, there was a strong association of the outcomes of poisoning with the toxic agent implicated for the poisoning.

Suicidal Nonorganophosphate Poisoning in a Tertiary Hospital in South India: Nature, Prevalence, Risk Factors

BACKGROUND

People who deliberately ingest poisons commonly present to emergency departments of hospitals in India. However, there is a dearth of information on poisoning using nonorganophosphorus pesticides.

METHODS

This prospective, hospital-based study attempted to examine the nonorganophosphorus poisons used to attempt suicide. Data on sociodemographic characteristics of patients, site and source of poisons, co-ingested substances, premeditation, and reason for poisoning were collected. A multinomial logistic regression was performed to determine association between poison class and these exposure characteristics.

RESULTS

Three hundred and forty-one cases of attempted suicide presented during the 6-month period (1.7% of all emergency room admissions). The majority was predominantly male and was young adults. Poisoning was the most common mode (91.7%), followed by hanging (7.3%) and self-injury (3, 0.9%). Pesticides (44.3%) including organophosphates (25.5%) were the predominant poisons, followed by pharmaceuticals (27.9%), caustics/chemicals (12.0%), and plant poisons (7.0%). One hundred and nine were available for prospective interview as the others who presented were not detained for prolonged observation the emergency department. Most patients who ingested such poisons were women, from rural backgrounds and were educated. The majority sourced the poisons from home, consumed poison at home, and mixed the poison with water; these attempts were impulsive and seemed to be in response to relationship conflicts. In the multivariate analysis, education (P = 0.08) and poison source (outside the home) were significant predictors of pesticide ingestion.

CONCLUSIONS

Suicidal poisoning results from a complex synthesis of socioeconomic and psychological factors; certain patterns of poisoning are likely to be more prevalent in demographic niche groups.

Pesticide poisoning in Chitwan, Nepal: a descriptive epidemiological study

Background

Globally, there is a growing concern over pesticides use, which has been linked to self-harm and suicide. However, there is paucity of research on the epidemiology of pesticides poisoning in Nepal. This study is aimed at assessing epidemiological features of pesticides poisoning among hospital-admitted cases in selected hospitals of Chitwan District of Nepal.

Methods

A hospital-based quantitative study was carried out in four major hospitals of Chitwan District. Information on all pesticides poisoning cases between April 1 and December 31, 2015, was recorded by using a Pesticides Exposure Record (PER) form.

Results

A total of 439 acute pesticides poisoning cases from 12 districts including Chitwan and adjoining districts attended the hospitals during the 9-month-long study period. A majority of the poisoned subjects deliberately used pesticides (89.5%) for attempted suicide. The total incidence rate was 62.67/100000 population per year. Higher annual incidence rates were found among young adults (111.66/100000 population), women (77.53/100000 population) and individuals from Dalit ethnic groups (98.22/100000 population). Pesticides responsible for poisoning were mostly insecticides (58.0%) and rodenticides (20.8%). The most used chemicals were organophosphates (37.3%) and pyrethroids (36.7%). Of the total cases, 98.6% were hospitalized, with intensive care required for 41.3%. The case fatality rate among admitted cases was 3.8%.

Conclusions

This study has indicated that young adults, females and socially disadvantaged ethnic groups are at a higher risk of pesticides poisoning. Pesticides are mostly misused intentionally as an easy means for committing suicide. It is recommended that the supply of pesticides be properly regulated to prevent easy accessibility and misuse. A population-based study is warranted to reveal the actual problem of pesticides exposure and intoxication in the community.

Scenario of organophosphate pollution and toxicity in India: A review

The present study on organophosphate deals with the reports on pollution and toxicity cases throughout India. The use of pesticides was introduced in India during the 1960s which are now being used on a large scale and represents the common feature of Indian agriculture. Use of organophosphates as a pesticide came as an alternative to chlorinated hydrocarbons due to their easy degradability. Although these xenobiotics degrade under natural condition, their residues have been detected in soil, sediments, and water due to their non-regulated usage practice. The over-reliance on pesticides has not only threatened our environment but contaminations of organophosphate residues have been also detected in certain agricultural products like tea, sugars, vegetables, and fruits throughout India. This paper highlights many of the cases where different organophosphates have been detected exceeding their respective MRL values. Some organophosphates detected are so hazardous that even WHO has listed them in class 1a and class 1b hazardous group. Presence of their residues in blood, milk, honey, and tissues of human and animals revealed their excessive use and bioaccumulating capabilities. Their intentional or unintentional uptake is causing thousands of deaths and severity each year. Most of the toxicity cases presented here are due to their uptake during a suicidal attempt. This shows how easily these harmful substances are available in the market.

Toxicoepidemiology of acute poisoning cases in a secondary care hospital in rural South India: A five-year analysis

Objective:

To ascertain the trend of poisoning cases admitted to the Government District Headquarters Hospital, a secondary care center in Udhagamandalam, Nilgiris District, Tamil Nadu, India, over a five-year period.

Materials and Methods:

The number of cases that presented to the hospital annually (incidence, mortality, and case fatality rates), socio-demographic pattern, and the nature of the poison were noted.

Results:

A total of 1860 poisoning cases (80 deaths) were reported during the period from October 2008 to September 2013. The incidence of poisoning was found to increase every year. The average incidence was 1.60 per 1000 population, while the average case fatality rate and mortality rates were 40.51 and 0.07, respectively. A total of 1148 (62%) were males. The majority of cases were seen in the 21-30 age group (41.24%). The poisonings were largely deliberate self-harm (n = 1,755; 94.35%), followed by accidental (n = 85; 4.57%). Agrochemicals were the main choice of poisoning agents and among these, organophosphates were the major cause.

Conclusion:

The data generated can help policy makers take decisions on the sale and availability of pesticides in this region.

Population-based characteristics of fatal and hospital admissions for poisoning in Fiji: TRIP Project-11

This study investigated the incidence and characteristics of poisoning fatalities and hospital admissions among indigenous Fijians and Indians in Viti Levu, Fiji. Individuals with a mechanism of injury classified as poisoning were identified using the Fiji injury surveillance in hospitals system, a population-based registry established for 12 months in Viti Levu, and analysed using population-based denominators. The mean annual rates of fatalities and hospitalisations were 2.3 and 26.0 per 100 000, respectively. Over two-thirds of poisonings occurred among people of Indian ethnicity. Most intentional poisoning admissions occurred among women (58.3%) and in 15-29-year-old individuals (73.8%). Unintentional poisoning admission rates were highest among Indian boys aged 0-14 years. While over 75% of events occurred at home, the substances involved were not systematically identified. The findings indicate the need for a strategy that addresses the differing contexts across age group, gender and ethnicity, and a lead agency responsible for implementing and monitoring its effectiveness.

Patterns of poisoning and drug overdosage and their outcome among in-patients admitted to the emergency medicine department of a tertiary care hospital

BACKGROUND

Poisoning and drug overdose (DO) are important health problems in developing countries. These emergencies are associated with high mortality and morbidity. Different factors affect the final outcome of patients. This study aims to review the pattern of poisoning and DO in an urban tertiary care hospital and also the determinants and final outcome of patients with poisoning and DO.

MATERIALS AND METHODS

Observational, retrospective hospital records-based study at a tertiary care hospital (15 months). Data on demography, hospitalization, complications, type of poison/drug and outcome of patients with poisoning and DO were collected. Data were analyzed using descriptive statistics, Chi square test and ANOVA. P < 0.05 was considered significant.

RESULTS

Of the total of 296 records, 213 were included (122 poisoning, 91 DO). Organophosphates (OP) (32.5%), pyrethroids (17.2%) and organocarbamates (12.2%) were the commonly used poisons. Sedatives and antiepileptics (21% each) were the common DOs. Poisoning among men was greater than that among women (P < 0.001). Outcome parameters of hospital stay and ventilator requirement were significant (P < 0.001). The overall case fatality rate was 2.4%.

CONCLUSIONS

OP compounds were the most common among poisons, while sedatives were frequently consumed drugs. Young adults from urban areas were the common victims with suicidal intention. Regulations, educational awareness and poison information centers will help to reduce the growth of this public health problem.

Profile of hospital admissions following acute poisoning from a major teaching hospital in North India

A retrospective analysis of 584 cases of acute poisoning admitted with a medical emergency to the Department of Medicine, GTB Hospital, Delhi, over a three-year period. The patients were analysed with respect to the age, sex, mode of poisoning, type of poison consumed and mortality. Of these, 42.63% were aged 20-30 years. Poisoning was used as a suicidal agent by 63.8% of the patients. The nature of the poison could not be ascertained in 15.92% of patients. Sedatives were involved in 13.36%. Aluminium phosphide poisoning was found in 11.82%. The overall mortality was estimated to be 13.18% with 53.2% being caused by the consumption of aluminium phosphide. There has been a change in the nature of poisons consumed and the number of cases of aluminium phosphide poisoning is declining. However, aluminium phosphide poisoning still remains a major threat as it carries a high mortality rate.

Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India

Background and Aim:

There is scarcity of data from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care units (ICU). We undertook this retrospective analysis to assess the course and outcome of such patients admitted in an ICU of a tertiary care private hospital.

Methods:

We analyzed data from 138 patients admitted to ICU with acute poisoning between July 2006 and March 2009. Data regarding type of poisoning, time of presentation, reason for ICU admission, ICU course and outcome were obtained.

Results:

Seventy (50.7%) patients were males and majority (47.8%) of admissions were from age group 21 to 30 years. The most common agents were benzodiazepines, 41/138 (29.7%), followed by alcohol, 34/138 (24.63%) and opioids, 10/138 (7.2%). Thirty-two (23%) consumed two or more agents. Commonest mode of toxicity was suicidal (78.3%) and the route of exposure was mainly oral (97.8%). The highest incidence of toxicity was due to drugs (46.3%) followed by household agents (13%). Organ failure was present in 67 patients (48.5%). During their ICU course, dialysis was required in four, inotropic support in 14 and ventilator support in 13 patients. ICU mortality was 3/138 (2.8%). All deaths were due to aluminium phosphide poisoning.

Conclusions:

The present data give an insight into epidemiology of poisoning and represents a trend in urban India. The spectrum differs as we cater to urban middle and upper class. There is an increasing variety and complexity of toxins, with substance abuse attributing to significant number of cases.

Pattern of acute adult poisoning at Tikur Anbessa specialized teaching hospital, a retrospective study, Ethiopia

Acute poisoning continues to be an important public health problem. Medical records of 116 adult patients presented to Tikur Anbessa Specialized University Hospital from January 2007 to December 2008 were reviewed retrospectively. Females outnumbered males. Mean age was 21 years. Most (96.5%) were intentional self-harm poisonings. Household cleansing agents were the leading causes of poisoning (43.1%) followed by organophosphate (21.6%) and phenobarbitone (10.3%). Loss of consciousness, vomiting and epigastric pain were the common presenting features accounting 46.2%, 23.8% and 22.5%, respectively. A total of 13(11.2%) patients had already known mental illness and 12 of them poisoned by using their own medications. Among 65 patients who reported their reason of poisoning, temporary quarrel (57%) and emotional disturbance (26%) were frequently cited. The case fatality rate was 8.6%. Death was most occurred by organophosphate (5/25) and phenobarbitone poisoning (3/12). Awareness on proper handling of chemicals and prescribed agents should be forwarded to users of these agents. Majority of patients poisoned for intentional self-harm purposes so that linkage of suicidal patients to appropriate mental health service is recommended. The availability of psychiatry consultation in the hospital is also recommended.

A study on poisoning cases in a tertiary care hospital

Acute poisoning with various substance is common everywhere. The earlier the initial resuscitations, gastric decontamination and use of specific antidotes, the better the outcome. The aim of this study was to characterize the poisoning cases admitted to the tertiary care hospital, Warangal district, Andhra Pradesh, Southern India. All cases admitted to the emergency department of the hospital between the months of January and December, 2007, were evaluated retrospectively. We reviewed data obtained from the hospital medical records and included the following factors: socio-demographic characteristics, agents and route of intake and time of admission of the poisoned patients. During the outbreak in 2007, 2,226 patients were admitted to the hospital with different poisonings; the overall case fatality rate was 8.3% (n = 186). More detailed data from 2007 reveals that two-third of the patients were 21-30 years old, 5.12% (n = 114) were male and 3.23% (n = 72) were female, who had intentionally poisoned themselves. In summary, the tertiary care hospitals of the Telangana region, Warangal, indicate that significant opportunities for reducing mortality are achieved by better medical management and further sales restrictions on the most toxic pesticides. This study highlighted the lacunae in the services of tertiary care hospitals and the need to establish a poison information center for the better management and prevention of poisoning cases.

Epidemiology of Cleistanthus collinus (oduvan) poisoning: clinical features and risk factors for mortality

Cleistanthus collinus (local name: oduvan) poisoning is a common suicidal poisoning method used in rural southern India. There are few studies on this issue and they have small sample sizes. This study examines the epidemiology of oduvan poisoning in a large sample, highlighting socio-demographic and clinical profile, complications, and risk factors for mortality. This study is a retrospective case series of 127 oduvan intentionally poisoned patients presenting at a tertiary care teaching hospital between the years 1990-1999. Descriptive statistics, cumulative case fatality rates and time to death from ingestion of poison were calculated. Cox regression adjusting for left truncation was used to investigate the effects of covariates on death. Patients' average (sd) age was 29.1 (10.9), 62% were female, 76% were married and 49% were housewives. The cumulative case fatality rate was 30%. The median time to death after oduvan ingestion was 3 days. Common signs and symptoms included hypokalaemia, vomiting, hyponatraemia, altered sensorium, bradycardia and abnormal ECG. There was a 58% risk reduction (95% CI: 29-75) in death with each 1 mmol/l increase in plasma potassium level. Patient's age was associated with an increased risk of death and the estimated hazard ratio for an increase of 10 years in age was 1.56 (95% CI: 1.18-2.07). Use of boiled oduvan extract was associated with an increased mortality (HR: 2.71, 95% CI: 1.17-6.32) compared to ingesting fresh leaves. Risk factors for oduvan poisoning mortality were hypokalaemia, older age, mode of consumption and an elevated risk for death with presence of chronic disease. When consumed as a boiled extract, oduvan is more lethal. We recommend close monitoring, correction of plasma potassium and appropriate supportive measures.