Pattern and pharmacotherapy of acute poisonings presenting to a tertiary care centre

Aravinda V., Ankita Bedwal, Kavitha Rajarathna, Narayana Swamy M.


Background: Acute poisoning, a therapeutic emergency and one of the common causes of morbidity and mortality globally. The rate of mortality in developed countries range from 1-2%, but in India it varies between 15-30%. According to World Health Organization (WHO), globally more than three million acute poisoning cases with 2,20,000 deaths occur annually. Most of the fatalities are due to the victim not reaching the hospital in time. This study aims to evaluate the pattern of acute cases of poisoning in tertiary care hospital attached to BMCRI.

Methods: Prospective, observational study based on hospital records at tertiary care hospital (twelve months). Data regarding demographic profile and treatment was collected. Data was analyzed using descriptive statistics and SPSS-24.

Results: Out of a total of 810 poisoning cases, 608 were included (381 poisoning, 138 drug overdose and 89 snake bite). Organophosphorus compounds (OPC) (131/608) and Aluminium phosphide (43/608) were the commonest poisons consumed in the age group 21-30 years. Sedative-hypnotics, non-benzodiazepine antiepileptics (non BZD AEDs) and paracetamol were common drug overdose cases. Snake bite accounted for 14.6%.

Conclusions: OP compounds were the most common among poisons, while sedatives-hypnotics were frequently consumed drugs, followed by Snake bite. Young adults from urban areas were the common victims with suicidal intention. This reflects the need for stringent rules regarding the availability and sale of drugs and poisonous substances.


Aluminium phosphide, Drug overdose, Organophosphorus compounds, Poisoning, Snake bite

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Karki RK, Risal A. Study of Poisoning Cases in a Tertiary Care Hospital. Kathmandu University Med J. 2012;10(4):70-3.

Pillay VV. MKR Krishnan’s Hand book of Forensic Medicine and Toxicology.12th Ed. Paras Publication. Hyderabad. 2001:76-299.

Sharma BR, Harish D, Sharma V. The epidemiology of poisoning: an Indian view point. J Forensic Med Toxicol. 2002;19:0971-1929.

National crime record bureau. Accident deaths and suicides in India. Indian Govt. publishing service; 2013. Available from:

World Health Organization. Guidelines for poison control Bulletin; Geneva, World Health Organization. 1999. Available from:

Anthony L, Kulkarni C. Patterns of poisoning and drug over dosage and their outcome among in-patients admitted to the emergency medicine department of a tertiary care hospital. Indian J Crit Care Med. 2012;16(3):130-5.

Eddelston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticides poisoning. 2008;371:597-607.

Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:e218.

Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Healt Organ. 1998;76:515-24.

Mookkappan S, Iqbal N, Basheer A, Vinay SSG. A clinic-epidemiological profile of organophosphorous compound poisoning, in puducherry. IOSR J Dent Medic Sci. 2015;14(9):51-6.

Unnikrishnan B, Singh B, Rajeev A. Trends of acute poisoning in South Karnataka. Kathmandu University Medic J. 2005;3(2):149-54.

Chowdary AN, Banerjee S, Brahma A, Biswas MK. Pesticide poisoning in nonfatal, deliberate self-harm: A public health issue. Indian J Psychiatry 2007;49:117-20.

Chowdary AN, Sanyal D, Dutta SK, Weiss MG. Deliberate self-harm by ingestion of poisons on Sagar island in Sunderban delta, India. Int Med J. 2003;10:85-91.

Sunder RJ, Kumar SS, Jayarajan A, Kuppuswamy G. Continuous infusion of high doses of atropine in the management of OP compound poisoning. J Assoc Physicians India. 1991;39:190-3.

Rao SCH, Venkateshwarlu V, Surender T, Eddleston M, Buckley NA. Pesticide poisoning in South India-opportunities for prevention and improved medical management. Trop Med Int Health. 2005;10:581-9.

Abdollahi M, Jalali N, Sabzevari O, Nikfar SH, Fallahpour M. Pesticide poisoning during an 18-month period (1995-1997) in Tehran, Iran. Irn J Med Sci. 1999;24:77-81.

Shadnia S, Esmaily H, Sasanian G, Pajoumand A, HassanianMoghaddam H, Abdollahi M. Pattern of acute poisoning in Tehran-Iran in 2003. Hum ExpToxicol. 2007;26:753-6.

Dash SK, Aluri SR, Mohanty MK, Patnaik KK, Mohanty S. Sociodemographic profile of poisoning cases. JIAFM. 2005;27:133-8.

Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum ExpToxicol. 2005;24:279-85.

Singh DP, Acharya RP. Pattern of poisoning cases at Bir hospital. J Institute Med. 2006;28:3-6.

Gupta SK, Peshin SS, Srivastava A, Kalukal T, Pandian TV. Epidemiology of acute poisoning. Natl Med J India. 2002;15(3);177.

Agarwal R, Barthwal SP, Nigam DK. Changing pattern of acute poisoning in eastern UP hospital based study. J Assoc Physic India. 1995;43:907-11.

Dhattarwal SK, Dalal SS. Profile of deaths due to poisoning in Rohtak Haryana in the 154 year 1995. Journ Forensic Med Toxicol. 1997;14:51.

Senanayake N, Petris H. Mortality due to poisoning in a developing and agricultural country: trends over 20 years. Hum Exp. Toxicol. 1995;14:808-11.

Yurumez Y, Durukan P, Yavuz Y, Ikizceli I, Avsarogullari L, Ozkan S et al. Acute organophosphorus poisoning in university hospital emergency room patients. Int Med J. 2007;46:965-9.

Manfredini R, Gallerani M, Caracciolo S, Tomelli A, Calò G, Fersini C. Circadian variation in attempted suicide by deliberate self-poisoning. BMJ. 1994;309:774-5.

Krupesh N, Chandrashekar TR, Ashok AC. Organophosphorus poisoning-still a challenging proposition. Indian J Anaesth. 2002;46(1):40-3.

Chugh SN, Sant Ram D, Arora B. Incidence and outcome of ALP poisoning in hospital study. Ind Med Res. 1992;94:232-35.

Jain AK, Nigam M, Garg SD, Dubey BP, Arora A. Aluminium phosphide poisoning autopsy findings. J Ind Academy Forensic Med. 2005;27:35-39.

Gargi J, Rai H, Chanana A, Rai G, Sharma G, Bagga IJ. Current trend of poisoning-a hospital profile. J Indian Med Assoc. 2006;104:72-3.

Cherian AM, Peter JV, Samuel J, Jaydevan R, Peter S, Joel S. Effectiveness of PAM in the treatment of organophosphorus poisoning. a randomized, double blind placebo controlled clinical trial. JAPI. 1997;45(1):219-24.

De Silva HJ, Wijewickrema R, Senanayake N. Does Pralidoxime affect outcome of management in acute organophosphorus poisoning. Lancet. 1992;339:1136-38.

Gururaj G, Issac MK. Epidemiology of suicides in Bangalore. NIMHANS publication no 43:29 May 2001. Available from:

Baby S, Haridas MP, Yesudas KF. Psychiatric diagnosis in attempted suicide. Calicut Medic J. 2006;4(3):e2.

Gouda Nagendra MR, Rao Sambaji M. Factors related to attempted suicide in Davangere. Indian J Comm Med. 2008;33(1).

Akhlaghi M, Arbabi Z, Khadivi R. Pattern of acute poisoning in Shahrekord. Asian J Epidemiol. 2009;2:9-12.

Shah R, Uren Z, Baker A, Majeed A. Trends in deaths from drug overdose and poisoning in England and Wales 1993-1998. J Public health. 2001;23:242-6.

Bennette PN, Brown MJ. Poisoning, overdose, antidotes. Clinical pharmacology. 10th ed, Churchill Livingston; 2010:961.

Dash SK, Aluri SR, Mohanty MK, Patnaik KK, Mohanty S. Sociodemographic profile of poisoning cases. JIAFM. 2005;27:133-8.

Fernandez W, Hackman H, Mckeown L, Anderson T, Hume B. Trends in opioid-related fatal overdoses in Massachusetts, 1990-2003. J Sub Abuse Treat. 2006;31(2):151-6.

Boldy DAR, Vale JA, Prescott LF. Treatment of phenobarbitone poisoning with repeated oral administration of activated charcoal. Q J Med. 1986;61:997-1002.

Kularatne SA. Epidemiology and clinical picture of the Russell’s viper (Daboiarusseliirussel) bite in Anuradhapura, Sri Lanka: a prospective study of 336 patients. Southeast Asian J Trop Med Public Health. 2003;34:855-62.

Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:e218.

Suleman MM, Shahab S, Rab MA. Snake bite in the Thar Desert. J Pak Med Assoc. 1998;48:306-8.

Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake bite in South Asia: a review. PLoSNegl Trop Dis. 2010;4:e603.

Chew KS, Khor HW, Ahmad R, Rahman NH. A five-year retrospective review of snakebite patients admitted to a tertiary university hospital in Malaysia. Int J Emerg Med. 2011;4:1-6.