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Indian Journal of Forensic Medicine & Toxicology

Pattern of poisoning reported at south Indian tertiary care hospital

Author(s): Kiran N, Shobha Rani R H, JaiPrakash V, Vanaja. K

Vol. 2, No. 2 (2008-07 - 2008-12)

Kiran N, Shobha Rani R H, JaiPrakash V, Vanaja. K

Department of Pharmacy Practice, Al-Ameen College of Pharmacy, Bangalore, India

Abstract

Background: Acute poisoning is a common medical emergency and one of the important causes of morbidity and mortality in developing countries due to easy availability of poisonous substances and its low cost. So it was important to know the pattern of poisoning at St Martha’s Hospital. Objective: To evaluate the pattern of poisoning at a tertiary care hospital in south India, Bangalore and to study the sociodemographic profile of the same. Methodology: A retrospective analysis of all poisoning cases admitted to the emergency department of St Martha’s Hospital from Jan 2006 to Oct 2007 was done to study the pattern of poisoning reported. Data on age and sex distribution, religion, type of poisoning and hospitalization stay were collected and analyzed. Results: A total of 148 patients (male: 93, female: 55) were included in the study. The age of the patients varied from 1-68 years. The male female ratio was 1.7:1. In more than 25 years of age, there was male predominance in all the age group. The types of poisons were insecticides like organophosphrous compound, halogenated insecticides, petroleum products, anti-inflammatory drugs, corrosive substance, barbiturate, rodenticides, etc. 60.23% of cases were intentional poisoning for suicidal attempt. The hospital stay of the admitted patients with poisoning ranged from 01 to 52 days. The mean hospital stay was 7.9 days. During the hospital stay, most of the cases were managed in Intensive Care Unit (ICU) services. In the study 22 cases had mortality. Conclusion: Intentional poisoning among young adults is a common public health hazardous. The commonest poisoning includes organophosphrous, halogenated insecticides, and petroleum products. Establishing a poison information centre (PIC), which should be networked with other PIC in India and also with developed countries, can help in early identification of the poisoning and also managing the cases by sharing the information. Awareness to the public regarding information on poison prevention has to be penetrated.

Key Words: Poisoning, Bangalore,

Introduction

Rapid industrialization and exposure to hazardous chemical products, introduction of newer range of drugs for treatment, massive use of pesticides in agriculture, increased alcohol consumption, unhealthy dietary habits has widened the spectrum of toxic products to which people have been exposed as compared with the early days1,2,3,4,5,6,7,8. Knowingly or unknowingly millions of people are exposed to danger by hazardous occupational practices and unsafe storage7,8 of toxic chemicals products in their day to day life. Lack of specialized toxicological services in developing countries like India has further contributed to the higher rate morbidity and mortality1,2,3,4,5.

Easy availability and low cost of hazardous chemicals plays a major role in both accidental and suicidal poisoning in developing countries like India, Srilanka, South Africa etc3,4,7,8,9,10. Most of the fatality rate is of intentional poisoning by organophosphrous (OP) compound which has been reported from southern and central India11,12,13. According to WHO (1999) more than three million poisoning cases has been reported out of which 251,881 deaths occur world wide annually, of which, 99% of fatal poisoning occur in developing countries, predominantly among farmers due to various kinds of poisoning, including poisonous toxins from natural products are handled13,14. Therefore, an alarm for early diagnosis, treatment and prevention is crucial in reducing the burden of poisoning related injury in any country.

A comparative data revealed that in developed countries, the mortality rate due to poisoning is only 1% to 2%, but in developing countries like India it varies between 15% to 30% [15] and is the fourth most common cause of mortality especially in rural India5,16. It is very difficult to draw a report to say which kind of poisoning is more frequent, has the nature of poisoning varies from one region another depending upon the poison availability and the knowledge and local population regarding the properties of poisons5. So this study has been aimed to determine the various parameters of poisoning such as type of poisoning involved, the most vulnerable age group and their marital status with religions.

Objective

  • To determine the age and sex distribution of poisoning cases reported.
  • To find out the pattern of poisoning reported to the hospital
  • To find out the duration of hospital stay.

Methodology

The present retrospective study was conducted by department of pharmacy practice from Jan 2006 to Oct 2007. Data was collected from all the poisoning cases admitted during this period to emergency department in St Martha’s Hospital, Bangalore, which is a tertiary care teaching hospital.

A total of 148 poisoning cases were admitted due to poisoning during the study period. Information was collected into a proforma on the type of poison consumed, incidence on age and sex, marital status, religions, hospitalization days were noted from records for each case and analyzed.

Results

In our study there were total of 148 patients brought to St Martha’s Hospital, of whom the data were collected during the 18 months study period from Jan 2006 to Oct 2007 due to suspected poisoning. Total number of male patients admitted to hospital due to poisoning was 93 (62.84% ) and female were 55 (37.16% ) with the male: female ratio being 1.7:1 (Table 1). Majority (64.86% ) of victims with suspected consumption of poison was in between 21-40 years followed by the age group between 1- 20 years (20.27% ) (Fig 1).

Most common poison used for suicidal purpose by the entire victim aged between 15-65 years irrespective of age. The reasons claimed for suicidal poisoning were like social problems (to get marriage, occupation and etc), economic and family burden, suffering from a chronic diseases, marriage unsuccessfulness, education problem and loss of work.

We also found that out 93 males came with poisoning, 51 (54.84% ) patients were married and 42 (45.16%) patients were unmarried. Out of the 55 females who admitted for poisoning 34 (61.82% ) patients were married and 21 (38.18%) were unmarried (Table 2). The suicide by poisoning was most common among the manual labourer.

The hospital stay of the admitted patients with poisoning ranged from 01 to 52 days and the mean hospital stay was 7.9 days. During the study period 22 cases (14.86%) of the patients had mortality due to poisoning and major was found to be organophosphrous compound poisoning.

The data retrieved from the case record revealed that about 113 patients (76.36%) with poisoning admitted to the hospital were Hindus followed by Muslims 22 patients (14.86%), Christians 10 patients (6.76%) and other classes 03 patients (2.02%) of religions (Table 3).

In common insecticides used for poisoning were organophosphrous compounds 89 cases (60.14%). 17 cases were reported for corrosive substance poisoning followed by rodenticides and petroleum products. Eight cases of barbiturate poisoning were reported during the study period (Fig 2). It clearly indicates that the poisonings is the most leading unnatural cause of rural burden of the morbidity and mortality in India.

Discussion

Committing for suicide is one of the oldest and considered the best trends of sacrificing their life by consuming different poisonous substances which are easily accessible to them compared to hanging or other methods of sacrificing. The morbidity, mortality in any case of acute poisoning depends upon number of factors such as nature of poison dose consumed, level of available medical facilities and time interval between intake of poison and provision of medical help.

The sex incidence affected with poisoning was more with male which out numbered the female the ration being 1.7:1 and tallies with the other studies4,10,17,18,19. In our study there is a male predominance (62.84%). The other studies showed the similar pattern with followed the studies done at Allahabad, Rohtak and Srilank. The high incidence may be because males are more exposed to stress, strain and occupational hazards compared to females5,13,20,21. In this study the most common age group involved was between 21-40 years followed by the age group between 1- 20 years. Most of the poisoning cases admitted were for suicidal purpose by the entire victim aged between 15-65 years irrespective of age. Thus, adolescent and young adults are at more risk and there is a need for intervention program. A pattern similar to this has been reported else where in India and abroad4,10,18,22,23,24.

The hospital stay of the admitted patients with poisoning ranged from 01 to 52 days. The mean hospital stay was 6.85 days. Similar findings were also observed in other studies as well. In the present study 89 cases (60.41%) were due to insecticidal organophosphrous poisons, which were the most commonly responsible agents for toxicity in poisoning cases. Similar types of findings were noted by the authors13,25,26. In this study we observed that married person more often become victim of poisoning which was found similar with other studies4,17,27. The reason of fact could be that the amount of stress carried by the married people on their day to day life is more than the single males or females which makes them more vulnerable to the poisoning.

We found the religious statistics of included patients who were admitted due to poisoning of which, 113 patients were Hindus (76.35%) followed by 22 patients (14.86%) were consuming different poisonous substances which are easily accessible to them compared to hanging or other methods of sacrificing. The morbidity, mortality in any case of acute poisoning depends upon number of factors such as nature of poison dose consumed, level of available medical facilities and time interval between intake of poison and provision of medical help.

Table 1: Showing incidence of sex.

Sex Number of Cases
(N=148)
Percentage (%)
Male 93 62.83
Female 55 37.17

Fig 1: Age Sex distribution

Table 2: Marital status of the victims

Marital status Number of Cases
(N=148)
Percentage (%)
Male Female
Married 51 34 57.43
Unmarried 42 21 42.57

Fig 2: Types of poison and drugs.

Table 3: Religion based distribution:

Religion Number of Cases
(N=148)
Percentage
(%)
Hindu 113 76.35
Muslim 22 14.86
Christian 10 6.76
Others 03 2.02

The sex incidence affected with poisoning was more with male which out numbered the female the ration being 1.7:1 and tallies with the other studies4,10,17,18,19. In our study there is a male predominance (62.84%). The other studies showed the similar pattern with followed the studies done at Allahabad, Rohtak and Srilank. The high incidence may be because males are more exposed to stress, strain and occupational hazards compared to females5,13,20,21. In this study the most common age group involved was between 21-40 years followed by the age group between 1- 20 years. Most of the poisoning cases admitted were for suicidal purpose by the entire victim aged between 15-65 years irrespective of age. Thus, adolescent and young adults are at more risk and there is a need for intervention program. A pattern similar to this has been reported else where in India and abroad4,10,18,22,23,24.

The hospital stay of the admitted patients with poisoning ranged from 01 to 52 days. The mean hospital stay was 6.85 days. Similar findings were also observed in other studies as well. In the present study 89 cases (60.41%) were due to insecticidal organophosphrous poisons, which were the most commonly responsible agents for toxicity in poisoning cases. Similar types of findings were noted by the authors13,25,26. In this study we observed that married person more often become victim of poisoning which was found similar with other studies4,17,27. The reason of fact could be that the amount of stress carried by the married people on their day to day life is more than the single males or females which makes them more vulnerable to the poisoning.

We found the religious statistics of included patients who were admitted due to poisoning of which, 113 patients were Hindus (76.35%) followed by 22 patients (14.86%) were Muslim, 10 patients (6.76%) were Christian and the remaining three patients (2.02%) were from other category. Major population of south India is of Hindu religions, and second populated leading religions is Muslim28. Out of the entire religious category Hindus are most exposed to agricultural and other hazardous occupation followed by Muslims. In this study, about 14.86% cases had mortality due to poisoning and most of them were of organophosphrous compound poisoning. In other studies the mortality ranged from 3-34% 4,18,25,26,27,28,29.

Conclusion

There is an urgent need for strict implementation of the Pesticide Act so that it could strengthen the legislature on availability of drugs and poisons substance in the market. This can regulate the import, manufacture, sale, transport, distribution and use of pesticides with a view to prevent risk to human beings. Enlightenment through educating young people about harmful effects of drugs, promoting poison information centres, introducing separate toxicological units in the hospitals and upgrading the peripheral health centres to manage cases of poisoning in emergency could possible help us to bring down the morbidity and mortality rate..

Acknowledgement

Authors wish to thank Medical Superintendent, St. Martha’s Hospital and Medical Records In charge and their staff for their support and encouragement during the study data collection.

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Corresponding address:
Mr. Kiran N
Lecturer, Dept of Pharmacy Practice, Al-Ameen College of Pharmacy
Hosur Road, Near Lalbagh Main Gate
Bangalore: 560027
Mob. : 09900594408
Email: kiran2119 (at) rediffmail.com

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