A cross sectional study of various types of acute poisoning; pharmacological management and their outcome in a tertiary care hospital
Keywords:Poisoning, Pesticide, Snakebite, Organophosphorus
Background: Acute poisoning is a common and life-threatening crisis, leading to serious complications and death of patients. Poisoning may be due to self-consumption, accidental exposure of chemical compounds, medications and poisonous animal bites/stings. Aim of current study was to investigate the pattern of drug utilization, poisoning agents and outcome in patients with acute poisoning treated at a tertiary care teaching hospital, Vadodara, Gujarat.
Methods: This prospective cross-sectional study was done on patients of acute poisoning admitted in emergency department, SSG Hospital during August 2021-March 2022.
Results: 400 patients were enrolled during the study, from which 262 (65.50%) were male and 138 (34.50%) were female. Mean age of patients was 30.30 ± 13.79 years. The commonest mode of poisoning observed was Suicidal (66.25%). The most common cause of poisoning was due to Pesticides (33.25%), followed by venomous animal exposures (30.75%). Death was recorded in 53 (13.25%) patients with highest number seen in suicidal poisoning (14.34%) compared to accidental poisonings (11.19%). Mainly, multivitamins (19.03%), Antimicrobials (16.65%), Proton Pump Inhibitors (15.85%) and Antiemetics (11.10%) were prescribed. Antidotes used were Atropine (4.81%), Pralidoxime (4.46%) and Anti-snake venom (2.80%). Median number of drugs per patient was 8; range: 2-25.
Conclusions: Pattern and magnitude of poisoning are multidimensional and demand multi-sectoral approach for facing this problem. Due to high incidence of snakebites, hospital stockpiles should be regularly checked for availability of antivenom. There is a need for stringent pesticide regulation laws, counselling and training programs to reduce incidence of poisonings and deaths due to it.
Aravind A, Rai M. Pattern of acute poisoning admissions in the medical intensive care unit of a tertiary care hospital. BMJ. 2014;6(3):239-42.
Chadha IA. Poisoning. BMJ. 2009;339(10):402-11.
Prevention and management of cases of poisoning. Available at: https://www.who.int/teams/ environment-climate-change-and-health/chemical-safety-and-health/incidents-poisonings/prevention-and-management-of-cases-of-poisoning. Accessed on 28 February 2023.
Chatterjee S, Verma V, Hazra A, Pal J. An observational study on acute poisoning in a tertiary care hospital in West Bengal, India. Perspect Clin Res. 2020;11(2):75-80.
Mathew R, Jamshed N, Aggarwal P, Patel S, Pandey RM. Profile of acute poisoning cases and their outcome in a teaching hospital of north India. J Family Med Prim Care. 2019;8(12):3935-9.
Modi’s Textbook of Medical Jurisprudence. Available at: https://knowledge.lexisnexis.in/pdf reader/textbook-medical-jurisprudence-toxicology50167841. Accessed on 27 February 2023.
Nikfar S. A cost and utilization study of antidotes. Int J Pharm. 2011;7(1):46-9.
Introduction to drug utilization research. Available at: https://apps.who.int/iris/bitstream/handle/10665/42627/924156234X.pdf?sequence=1&isAllowed=y. Accessed on 27 February 2023.
Chary RS, Suraj S, Mittal C, Jamshid P. Study of poisoning trends in South India: A perspective in relation to Indian statistics. J Indian Soc Toxicol. 2017;13:21 6.
Gupta P, Kumar A, Singh SP, Prakash M, Gupta M, Kumar P. Pattern of Cases of Acute Poisoning in a Rural Tertiary Care Center in Northern India. Nat J Community Med. 2016;7(4):307-10.
Khan Pamdckm and Nousheen B. A study on treatment pattern and outcomes of poisoning cases in a tertiary care and government district hospital. Int J Pharm Pharm Sci. 2017;9(4)):193-7.
Kanchan T, Menezes RG, Mohan Kumar TS, Bakkannavar SM, Bukelo MJ, Sharma PS. Toxicoepidemiology of fatal poisonings in Southern India. J Forensic Leg Med. 2010;17(6):344-7.
Gargi J, Tejpal HR, Chanana A, Rai G, Chaudhary R. A retrospective autopsy study of poisoning in the northern region of Punjab. J Punjab Acad Forensic Med Toxicol. 2008;8(2):17-9.
Z’gambo J, Siulapwa Y, Michelo C. Pattern of acute poisoning at two urban referral hospitals in Lusaka, Zambia. BMC Emerg Med. 2016;16(1):2.
Maheswari E, Abraham L, Chacko CS, Saraswathy GR, Ramesh AC. Assessment of pattern, severity and outcome of poisoning in emergency care unit. J App Pharm Sci. 2016;6(12):178-83.
John NA, John J. Prolonged use of mosquito coil, mats, and liquidators: A review of its health implications. Int J Clin Experiment Physiol. 2015; 2(4):209-13.
Bamathy B, Punnagai K, Amritha CA, Darling Chellathai D. Incidence & patterns of acute poisoning cases in an emergency department of a tertiary care hospital in Chennai. Biomed Pharmacol J. 2017; 10(3):1285-91.
Maharani BVN. Profile of poisoning cases in a tertiary care hospital, Tamil Nadu, India. J Appl Pharm. 2013; 3:91-4.
Ramesha KN, Rao KBH, Kumar GS. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India. Indian J Crit Care Med. 2009;13(3):152-5.
Banerjee I, Tripathi SK, Roy AS. Clinico-epidemiological profile of poisoned patients in emergency department: A two and half year's single hospital experience. Int J Crit Illn Inj Sci. 2014;4:14-7.
Asari PD, Shah SM, Amin AJ, Patel ND. Drug Utilization Study on Acute Poisoning Cases Treated at a Tertiary Care Hospital in Western Part of India. Asia Pacific J Med Toxicol. 2016;5(10):20-4.
Afshari R. Non-medical use of medications in middle and low income countries. Asia Pac J Med Toxicol. 2014;3:49.
Kularatne SA, Kumarasiri PV, Pushpakumara SK, Dissanayaka WP, Ariyasena H, Gawarammana IB, Senanayake N. Routine antibiotic therapy in the management of the local inflammatory swelling in venomous snakebites: results of a placebo-controlled study. Ceylon Med J. 2005;50:151-5.
Priyendu A, Vandana KE, Varma M, Prabhu N, Rahim AA, Nagappa AN. Antibiotic prophylaxis in organophosphorus poisoning: A study of health and economic outcomes. Saudi Pharm J. 2016;23:32-8.
Vaidya Y, Hulke S. Study of trends of poisoning in the cases reported to government hospital, Yavatmal. Chronicles Young Sci. 2012;3(1):63.
Mittal C, Singh S, Kumar-M P, Varthya SB. Toxicoepidemiology of poisoning exhibited in Indian population from 2010 to 2020: A systematic review and meta-analysis. BMJ Open. 2021;11(5):1-9.
Asawari R, Atmaram P, Bhagwan K. Toxicological pattern of poisoning in urban hospitals of western India. J Young Pharm. 2017;9(3):315-20.
Rao KN, Babu PS and Acharya A. A prospective study of pattern of acute poisoning and treatment outcome in paediatric age group in tertiary care hospital of Konaseema region of Andhra Pradesh, India. Int J Contemp Pediatr. 2018;5(2):576.
Due P, Nguyen NT. The Achievements of the Poison Control Center of Bach Mai Hospital, Vietnam. Asia Pac J Med Toxicol. 2013;2:118.