Epidemiology of Chemical Poisoning among Adults in Qassim Region: An Eight-Year Study

Outbreak of carbofuran and bifenthrin poisoning in siblings after ingestion of contaminated food in KSA: Clinical management and public health implications

Background

Pesticide poisoning remains a major global health concern contributing to an estimated 371,594 deaths annually. Both accidental and deliberate pesticide exposure, particularly in developing countries, pose challenges to public health systems. In KSA, pesticide poisoning is prevalent, and insecticides such as carbamates and organophosphates are the primary culprits.

Case presentation

Four cases of acute poisoning caused by the ingestion of contaminated shawarma sandwiches containing carbofuran and bifenthrin, a carbamate and pyrethroid mixture, respectively, are described. The affected individuals, all siblings, exhibited varying degrees of cholinergic symptoms, including muscle fasciculations, excessive secretions, and respiratory distress. Despite their severe symptoms, three patients had normal or low-normal acetylcholinesterase levels, probably because of individual variability, delayed testing, or improper sample handling. One patient exhibited diminished acetylcholinesterase activity, thus suggesting severe inhibition; pancreatitis was a further complication that contributed to delayed recovery. Early clinical management included atropine, pralidoxime, and botulinum antitoxin, because of initial suspicion for botulism. Toxicological analysis confirmed carbofuran poisoning, and food safety investigations identified improper pesticide use in food preparation areas.

Conclusion

The reported cases underscore the importance of timely toxicological consultation, proper testing, and appropriate sample handling to guide treatment of pesticide-related poisoning. These findings highlight the crucial need for adherence to WHO regulations and monitoring of pesticide use, as well as strict food safety practices to prevent future outbreaks. The successful multidisciplinary approach to managing these cases demonstrates the critical role of coordinated efforts between clinical teams and public health authorities in addressing such public health threats.

Exploring the Landscape of Adult Acute Poisoning in Saudi Arabia: A Comprehensive Narrative Review

This narrative review meticulously examines the intricate landscape of poisoning incidents within Saudi Arabia, delineating the prevalence and characteristics across three main categories: pharmaceutical, illicit, and chemical substances. Pharmaceutical agents, particularly analgesics and antipsychotics, are identified as leading causes of acute adult poisoning, highlighting the paramount role of their widespread accessibility and the potential risks associated with over-the-counter availability. The review underscores the alarming prevalence of over-the-counter analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), as the most frequent culprits in poisoning cases, with a significant correlation observed between analgesic poisoning and gender, notably affecting the female population. Additionally, the study delves into the burgeoning issue of illicit drug use, with opioids and amphetamines emerging as substantial contributors to the poisoning landscape, reflecting a broader global trend of increasing substance misuse and its associated health risks. Chemical poisoning, encompassing a range of substances from household cleaners to industrial chemicals, presents another critical area of concern, with specific emphasis on the dangers posed by antiseptics, detergents, and organophosphates. The review identifies a pressing need for targeted public health interventions and policy reforms aimed at mitigating the risks associated with these diverse types of poisoning. By offering a comprehensive overview of the poisoning epidemiology in Saudi Arabia, the study contributes valuable insights into the multifaceted nature of this public health challenge, advocating for enhanced regulatory measures, public awareness campaigns, and improved access to mental health services to address the underlying factors contributing to poisoning incidents.

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

BACKGROUND

In clinical practice, some patients might not be able or unwilling to provide a thorough history of medication and poison exposure. The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.

METHODS

This was a retrospective and descriptive study from an institute of poisoning. Patient registration information and test reports spanning the period from April 1, 2020 to March 31, 2022, were obtained. Patients with uncertain exposure histories and who underwent toxicological analysis were included. Clinical manifestations and categories of toxics were analyzed.

RESULTS

Among the 195 patients with positive toxicological analysis results, the main causes of uncertain exposure history was disturbance of consciousness (62.6%), unawareness (23.6%) and unwillingness or lack of cooperation (13.8%). The predominant clinical manifestations were disturbed consciousness (62.6%), followed by vomiting and nausea (14.4%) and liver function abnormalities (8.7%). A comparison of clinical manifestations between patients with positive and negative (n=99) toxicological analyses results revealed significantly different proportions of disturbances in consciousness (63% vs. 21%), dizziness (1.5% vs. 5.1%), multi-organ failure (1.5% vs. 7.1%), and local pain (0 vs 4%). The main categories of substances involved were psychiatric medications (23.1%), sedatives (20.5%), insecticides (13.8%), and herbicides (12.8%).

CONCLUSION

The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific, and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

A Retrospective Study of Epidemiological Correlations of Food, Drug and Chemical Poisoning in Al-Baha, Western Saudi Arabia

Poisoning is a common and severe problem worldwide. Due to significant growth in the agricultural, chemical, and pharmaceutical industries over the past few decades, poisoning risks have increased with the use of food, chemicals, and medicines everywhere in the world, especially in Saudi Arabia. Advanced information on acute poisoning patterns is critical for the effective management of poisoning events. This study aimed to examine the characteristics of patients with various patterns of acute poisoning, caused by food, drugs, and chemicals, that were reported to the Department of Toxicology and Poison Center at King Fahad Hospital and the Poison Center in Al-Baha Province, Saudi Arabia. The study also examined the relationship between demographic characteristics, including age, toxin type, and geographical distribution, and poisonings in Baha Province. This retrospective cross-sectional analysis included 622 poisoning cases. The data were collected from 2019 to 2022 and it was found that out of 622 instances, 159 had food poisoning, with more men than females sick (53.5% male and 46.5% female), 377 had drug poisoning (54.1% males and 45.9% females), and 86 had chemical poisoning (74.4% males and 25.6% females). This study found that the most prevalent agents implicated in acute poisoning were medicines, particularly analgesics and antipsychotic drugs. Food poisoning was the second most common acute poisoning, affecting largely males followed by female patients. Finally, chemical poisoning involved acute poisoning, with most cases involving methanol and household items including the strongest bleaches (chlorines) (Clorox^®, Oakland, CA, USA). Insecticides and pesticides were also secondary sources of chemical poisoning. Additional research revealed that the incidence of food, chemical, and drug poisoning was highest in children aged 1-15 years (food poisoning, n = 105, 66%; drug poisoning, n = 120, 31.8%); patients aged 11-20 years had the highest incidence of chemical poisoning (n = 41, 47.7%). Most poisoning incidents among youngsters are caused by easy access to drugs at home. Implementing strategies to enhance public awareness and limit children's access to drugs would contribute considerably to decreasing the community's burden of this problem. The findings of this study suggest that Al-Baha should improve its education regarding the rational and safe use of drugs and chemicals.