Analysis of different types of poisoning in a tertiary care hospital in rural south india

doi:10.1016/j.fct.2010.10.026

Food and Chemical Toxicology

Volume 49, Issue 1, January 2011, Pages 248-250

https://doi.org/10.1016/j.fct.2010.10.026 Get rights and content

Abstract

The global problem of acute poisoning has steadily increased over the past few years. It is an important cause of morbidity and mortality in developing countries. Better preventive and management strategies can be developed if the incidence and pattern of acute poisoning is known. The study aims at analyzing the pattern, cause and mortality rate of poisoning.

The study was conducted in a rural area in South India. This retrospective study was conducted from January 2003–December 2003. The data was analysed using descriptive statistics.

Out of the 225 cases 139 were males and 86 females. Poisoning was common in the age group of 21–30 years which was 84 cases and 11–20 years was 73 cases. The poisons consumed were as follows: Organophosphorous 135 cases, aluminum and zinc phosphide 50 cases, phenobarbitone 18 cases, benzodiazepines 7 cases, paracetamol 2 cases, miscellaneous 13 cases. 94% were suicides and 6% accidental. Mortality rate was 12.8%.

Establishment of strict policies against the sale and availability of pesticides and over the counter drugs is an effective way to control organophosphorous and drug poisoning.

Introduction

Poisoning constitutes an important entity among the seriously ill patients admitted in every hospital. The causes, pattern and outcome of poisoning in a particular community depends on a variety of factors such as easy availability of a particular poison, stress pattern and the standard of the emergency medical care (Senewirathane and Thambipillai, 1974). The easy availability of agricultural chemicals and over the counter drugs especially in developing countries may result in a pattern of poisoning different from that seen in western countries (Senewirathane and Thambipillai, 1974). These chemicals and drugs some of which are highly lethal and whose sale cannot be effectively controlled, are freely available in many rural areas. In addition, special units to deal with cases of poisoning are lacking in these areas.

Studies have suggested that there is an increase in the number of death in rural setup especially among the younger age group; agricultural poisons such as insecticides are largely responsible for this possibly due to easy access. In this study we intend that a survey of the problem would help to assess the scenario and the cause of poisoning and would determine what preventive steps could be taken to decrease the incidence of poisoning and its mortality.

(1)
To evaluate the pattern and cause of poisoning.
(2)
To evaluate the mortality rate due to poisoning.

Section snippets

Methodology

This study was conducted by the departments of Pharmacology and Medicine at Sri R.L. Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar. This is a tertiary care hospital situated in a rural area in Karnataka, South India. This was a retrospective study designed based on case series analysis. All patients admitted to the medicine department with history of poisoning during January 2003–December 2003 were included in this study and they constituted a sample of

Results

A total of 225 patients with poisoning were included in the study. Out of these 139 patients (62%) were males and 86(38%) were females (Table 3.1.1).

Among the 225 patients who had consumed the poison 78(35%) were married males and 61(27%) were unmarried males. Among the females, 52(23%) admitted were married and 34(15%) unmarried (Table 3.1.1).

Most of the patients belong to upper middle socioeconomic status i.e. 195 cases (87%). Sixty-seven cases (30%) in the study group had completed their

Discussion

The occurrence of 225 cases of poisoning in a single hospital over a period of one year with a mortality rate of 12.8% emphasizes the seriousness of the problem of poisoning in rural areas. We observed that the percentage of males consuming poison largely outnumbered the females. This observation is in concordance with other studies who observed a male predominance (Kanchan and Menezes, 2008, Singh and Unnikrishnan, 2006, Bhattarai et al., 2006).

Studies conducted in south India shows that

Conclusion

Stringent rules and regulations have to be implemented against the use of pesticides and over the counter drugs. Young adults should be educated about the hazards in the use of these chemicals. Establishing a counseling centre in each hospital would give an opportunity for the risk group to be counseled thereby addressing the root cause. Separate toxicology units may be set up in all hospitals to deal with these emergencies. This enables quick and efficient treatment for the patients. All the

Conflict of Interest

The authors declare that there is no conflict of interest.

References (18)

T. Kanchan et al.
Suicidal poisoning in southern india:gender differences
J. Forensic. Leg. Med.
(2008)
B. Singh et al.
A profile of acute poisoning at mangalore(south India).J
Clin. Forensic.
(2006)
N. Bhattarai
Patterns of organ phosphorous poisoning attending a teaching hospital’s
Nepal. Med. Assoc.
(2006)
S.K. Dhattarwal et al.
Profile of death due to poisoning in Rohtak Haryana in the year
J. Med. Toxicol.
(1995)
R.S. Gulati
Spectrum of acute poisoning in a service hospital
J. Assoc. Physicians India.
(1995)
B.D. Gupta et al.
Profile of fatal poisoning in and around Jamnagar
JIAFM
(2005)
J. Jayarathnam
Acute pesticide poisoning. A Major global health problem
World.health statist. Quart.
(1990)
N. Kiran
Pattern of poisoning reported at a southern Indian tertiary care hospital
Indian J. Forensic Med. Toxicol.
(2008)
S. Nirmal et al.
Pattern of acute poisoning in a medical unit in central Sri lanka.For
Sci. Int.
(1988)

There are more references available in the full text version of this article.

Cited by (43)

Estimation of chlorpyrifos distribution in forensic visceral samples and body fluids using LCMS method
2022, Journal of Forensic and Legal Medicine
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.
Toxico-epidemiology of acute poisoning; an exploratory study from a tertiary care hospital in South India along with global comparisons and solutions
2021, Journal of Forensic and Legal Medicine
Citation Excerpt :
A similar trend was observed in many studies across India but the type of pesticides used varied between different regions within the country. Studies from South India showed a predominance of Organophosphates10,11 whereas reports from North India revealed that Aluminium Phosphide12,13, a more lethal pesticide, was the major poison used there. Thus, it is very clear that regional variations and socio-demographic factors therein play a vital role in determining the pattern of poisoning.
Poisoning has been and still is a major problem faced throughout the globe. But its patterns are different and changing in different parts of the world due to local influences. This calls for a study to explore the issue in this unique South Indian state.
A cross-sectional exploratory study was conducted to analyse the patterns of poisoning and the socio-demographic characteristics of the patients. Subgroups were compared using Fisher-Freeman-Halton exact test and further analysed by multivariate logistic regression.
48% of cases were of pharmaceutical drug poisoning. 27.5% of these cases involved polymedication and Paracetamol (Acetaminophen) turned out to be the single most drug used. Suicide was the most common circumstance. 10% of patients had co-diagnoses of psychiatric disorders. Univariate analysis separately showed that females (p < 0.001), higher educated (p = 0.149), higher socioeconomic strata (p = 0.136) and non-addicts (p = 0.002) were more exposed to drugs whereas males, lower educated, lower socioeconomic strata and addicts are skewed to pesticides for poisoning. Most repeat suicide attempts were with the same poisonous agent. 70% of patients with a diagnosed psychiatric disorder have attempted suicide before using some drugs (p < 0.001).
Our study highlights the importance of a region-wise, targeted approach in policymaking to curb poisoning.
A retrospective analysis of data from forensic toxicology at the Academy of Forensic Science in 2017
2019, Forensic Science International
Citation Excerpt :
In Japan, poisoning by carbon monoxide showed the highest frequency [17]. In India, organophosphorus pesticide was the most frequent substance leading to poisoning [58]. In Pakistan, poisoning with benzodiazepine was the most common cause of poisoning [72].
Knowing the specific pattern of forensic toxicology cases in a region is vital to help the local government establish an effective prevention and treatment system; currently, there have been no published reports investigating various types of forensic toxicology cases based on a large autopsy series and city size. The data in this study were obtained from records kept at the Academy of Forensic Science (AFS) between February 2017 and December 2017, and the cases were mainly from the Public Security Organs People’s Police in Shanghai, China. There were 299 autopsies; the leading cause of death was traffic accidents (37.1%), and the manners of death were mainly accidental (54.8%). From a total of 9083 cases, 1992 involved traffic accidents, 6787 were drug abuse, 269 were poisonings, and 35 were drug-facilitated sexual assaults (DFSAs). We also investigated the pattern of unnatural deaths and the alcohol-positive (with a blood alcohol concentration (BAC) ≥0.20 mg/ml) rate among the various cases. The BAC ranged from 0.08 to 7.24 mg/ml in traffic cases, and the mean BAC of the total alcohol-positive drivers was 1.44 mg/ml. It was found that 80.8% of the drivers involved had a BAC ≥ 0.20 mg/ml (limit of civil offense), and 72.8% had a BAC ≥ 0.80 mg/ml (limit of criminal offense). Among the drug abuse cases, there were 4073 cases (60.0%) that were positive for at least one euphoriant; the most frequently abused drug group was amphetamine-type stimulants (ATS). Poisonings by natural toxins (such as scopolamine and tetrodotoxin) account for a significant portion of accidental deaths. Pesticide poisoning was also constituted a large portion, and organophosphorus were the cause of the majority of those cases. Suicide by pesticide showed the highest frequency in the present study. Among the 35 DFSA cases, dexmedetomidine was frequently detected in our study, which has rarely been reported previously in DFSA cases.
Poisoning due to household products: A ten years retrospective analysis of telephone calls to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi, India
2018, Journal of Forensic and Legal Medicine
Citation Excerpt :
Ironically, poisoning is largely preventable and treatable, but the suffering continues, due to low priority and inadequate attention to the problem, and thus the paucity of health programmes. The nationwide data, based on some regional and hospital based studies and police records implicate poisoning as an important causes of morbidity and mortality in India.4,5 However, the exact incidence of poisoning is not known, because there is no central registry of poisoning cases.
Extensive use of different chemicals in various fields and their easy availability has led to an increased incidence of accidental and intentional poisoning in developing countries including India. A diverse range of household products commonly used for domestic purposes comprise pesticides, household cleaners, thermometer mercury, antiseptics, kerosene, paint thinners etc. Any of these products, if misused or mishandled can cause poisoning. In India, the National Poisons Centre (NPIC) at the All India Institute of Medical Sciences, New Delhi, provides information on management of poisoning to treating physicians. Analysis of data based on telephone calls received by the NPIC (April 2006–March 2016) has highlighted a high incidence of poisoning due to household products, followed by pharmaceuticals, agricultural pesticides and industrial chemicals. The objective of the present retrospective study was to determine the incidence of poisoning due to various household products as reported to the NPIC during the ten years period. The total number of calls received by the Centre was 16,420. There were 7114 calls (45.5%) due to household products with adults (>18yrs.) and children (<1–18yrs.) constituting 38.7% and 61.2% calls respectively. Males outnumbered females (M = 62.4%, F = 37.5%). The mode of poisoning was mainly unintentional (66.8%) followed by intentional mode (33.2%). The commonest route of exposure was oral (95.6%). Household pesticides were commonly implicated (43.7%) followed by household cleaners (21.8%), thermometer mercury (5.2%) naphthalene balls (5%), antiseptics (3%), kerosene (2%) and paint thinner (2%). Miscellaneous products comprising of camphor, silica gel, hair dye, nail polish remover, cosmetics, adhesives etc were also involved in poisoning (17.1%). The trend and pattern of poisoning varies in different parts of the country, because all calls on poisoning are not reported to the Centre. So the data as such may not be a true reflection of the scenario in India. However, the results do indicate an increasing incidence of poisoning due to household products especially in children. The probable reasons for high incidence could be careless storage, ignorance, non compliance with prescribed instructions for use and negligible parental supervision in case of children. The results of the study highlight, an urgent need to identify high risk circumstances, common toxic products involved and implementation of prevention and awareness programmes, to achieve poisons control at home.
Toxico-vigilance – An inevitable prerequisite to keep a watch on toxins around you
2017, Journal of Forensic and Legal Medicine
Citation Excerpt :
Likewise, a 7% raise in rate of suicidal poisoning is observed in USA from 2000 to 2006.5 In same scenario in India, various studies conducted in the hospitals report major poisoning cases involving pesticides.6,7 Although a lot of under reporting of such cases is a common phenomenon and practice in developing countries such as in India.
India has got a handful of poison centers to compensate about 1.25 billion population of India. Hence, a lot of under-reporting of poisoning cases occurs due to limited resources. Gujarat being an upcoming industrial centre of India has got many key industries like textiles, automobiles, chemicals, diamonds, pharmaceuticals etc. This magnificent industrial growth has resulted upon increased exposure of various hazardous chemicals among the general and working population. This study reflects trends of poisoning observed in a poison center named Center For Education Awareness and Research On Chemicals and Health (CEARCH) at Ahmedabad. A retrospective study of around 659 cases were analytically analyzed which have been reported at CEARCH. Variables considered for analysis are age, gender, route of exposure, intention, agent group, agent subgroup and agent name. Out of which 274 cases of females, 384 cases were of males and one case of a transgender was reported. Maximum poisoning cases reported were of pesticides (57.35%) followed by pharmaceuticals (21.24%), industrial chemicals (6.22%), metals (5%), substance of abuse (3.94%), plant poisons (1.82%), household chemicals (1.36%), mixture of more than one agent (1.36%), herbicides (0.75%), animal poisons (0.45%), bacterial poisons (0.30%) and other poisons (0.15%). The data analysis reports that among all the routes of exposure, Oral route (94%) is the major route of exposure followed by inhalation (4%), dermal and injections respectively clearly emphasizing the need for appropriate steps towards the protection of the most vulnerable populations from the consequences of the pervasive poisons exposure.
Clinical analysis of acute poisoning in children
2024, BMC Pediatrics

View all citing articles on Scopus

View full text

Analysis of different types of poisoning in a tertiary care hospital in rural south india

Abstract

Introduction

Section snippets

Methodology

Results

Discussion

Conclusion

Conflict of Interest

J. Forensic. Leg. Med.

Clin. Forensic.

Patterns of organ phosphorous poisoning attending a teaching hospital’s

Nepal. Med. Assoc.

Profile of death due to poisoning in Rohtak Haryana in the year

J. Med. Toxicol.

Spectrum of acute poisoning in a service hospital

J. Assoc. Physicians India.

Profile of fatal poisoning in and around Jamnagar

JIAFM

Acute pesticide poisoning. A Major global health problem

World.health statist. Quart.

Pattern of poisoning reported at a southern Indian tertiary care hospital

Indian J. Forensic Med. Toxicol.

Pattern of acute poisoning in a medical unit in central Sri lanka.For

Sci. Int.