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ORIGINAL ARTICLE
Year : 2015  |  Volume : 42  |  Issue : 3  |  Page : 156-160

A profile of acute poisonings: A retrospective study


Department of Community Medicine, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India

Date of Web Publication16-Sep-2015

Correspondence Address:
Asso. Prof. Thalappillil Mathew Celine
Department of Community Medicine, MOSC Medical College, Kolenchery, Ernakulam, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.165547

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  Abstract 

Background and Objective: Intentional self-poisoning is a major problem in developing countries. Thus, the main objective of this study was to characterize the poisoning cases and related mortality among patients admitted with poisoning in a tertiary care hospital during the period from April 1, 2005 to March 31, 2010. Materials and Methods: A retrospective study conducted on hospitalized patients admitted with poisoning. Data were collected from the registers kept in the medical records department, which follows the guidelines of International Classification of Diseases-10 coding. Results: Of 2018 cases, 1178 (56.6%) were males and 903 (43.4%) females. Most of the cases were in the age of 26-45 years. Of the total cases, 412 (19.8%) admitted with organophosphorus and carbamate insecticides poisoning. Among them, males 264 (22.4%) were more than females 148 (16.4%). Case fatality rate due to poisoning was 7.8% (162 deaths). Of the total deaths, 66.0% were occurred among males and 34% among females. Of the deaths, 35.2% deaths were due to organophosphorus and carbamate insecticides poisoning. Case fatality due to organophosphorus and carbamate insecticides poisoning was 13.8%. Conclusion: In the present study organophosphorus and carbamate insecticides poisoning cases and its mortality were high. The easy availability of dangerous poisons from the shops should be restricted for controlling these types of poisonous deaths.

Keywords: Case fatality, organophosphorus, pesticides, poisoning


How to cite this article:
Celine TM, Antony J. A profile of acute poisonings: A retrospective study. J Sci Soc 2015;42:156-60

How to cite this URL:
Celine TM, Antony J. A profile of acute poisonings: A retrospective study. J Sci Soc [serial online] 2015 [cited 2022 Aug 17];42:156-60. Available from: https://www.jscisociety.com/text.asp?2015/42/3/156/165547


  Introduction Top


Poisoning was a common form of purposeful self-harm in the developing world. Poisoning was very common, and its mortality is very high in the developing countries. People who were living near the plantations, which were using highly poisonous pesticides were suffering from congenital deformities, physical disabilities, mental retardation, and gynecological problems. [1]

David's et al. study showed that about one-third of the world's suicide cases was due to the use of pesticides. Among the suicide cases, the proportion of pesticide cases was varied from 4% in the European region to above 50% were found in the Western Pacific region. [2] Suicide was a major problem in the developing world, it was the main cause for about 600,000 deaths in 1990. The mortality due to poisoning was very high in the tropics than in the industrialized countries because of the toxicity of accessible poison and scarcity of medical services. The mortality and disabilities due to poisoning are increasing because people use highly poisonous chemicals for suicides, which were easily available in shops.

The study on Global Burden of Disease [3],[4] reported that 593,000 people killed themselves in the developing world during 1990 and 75% of the total deaths were due to self-harm in the world. [3] Poisonings were more common among young children (<10 years), but their mortality rate was low in both developing and developed countries. Several studies mentioned that most of the poisoning deaths occurred due to intentional poisoning. [5],[6],[7],[8]

Intentional self-poisoning due to organophosphorus is very high in the southern region of India because it easily available in these regions. [9] Snakebite poisoning is another common type of poisoning among people in rural areas at the time of wet weather and rainy season. [10] In India, snake bite is one of the most common causes of morbidity and mortality. Mortality due to this type poisoning in each year in India is about 35,000-50,000. [11] The aim of the study was to characterize the poisoning cases and related mortality among patients admitted with poisoning.


  Materials and Methods Top


Study design

A retrospective study on patients admitted with poisoning in a tertiary care level in the Ernakulam district of Kerala from April 1, 2005 to March 31, 2010.

Selection of description of patients

The study population consisted of all patients admitted with poisoning. Data were collected from the medical records department. The data were collected with the permission of Institutional Ethical Committee. Medical record department follows the guidelines of International Classification of Diseases-10 coding.

Statistics

Microsoft excel was used for the analyzing the data. Frequency distributions and case fatality rates were analyzed.


  Result Top


Of the 2018 poisoning cases, 1178 (56.6%) were males and 903 (43.4%) were females admitted in a teaching hospital during the period from April 1, 2005 to March 31, 2010.

Most of the poisoning cases were reported in the age group of 26-45 years as shown in [Table 1].
Table 1: Age sex distribution of patient admitted with poisoning from April 1, 2005 to March 31, 2010


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Most of the cases were due to toxic effects of substances chiefly nonmedical as to source and the distribution was same among both males and females as shown in [Table 2].
Table 2: Sex wise distribution of type poisoning cases reported in a teaching hospital during the period from April 1, 2005 to March 31, 2010


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Of the toxic effects of substances chiefly non-medical as to source, 412 (43.6%) was due to organophosphorus and carbamate insecticides poisoning, 25 (2.6%) due to herbicides and fungicides poisoning, 124 (13.1%) due to toxic effect of venomous animals and 98 (10.4%) was due to snake venom. Of the toxic effect of venomous animals, 98 (79.0%) cases was due snake venom poisoning.

Of the total cases 412 (19.8%) were due to organophosphorus and carbamate insecticides poisoning. It was more in males 264 (22.4%) than females 148 (16.4%). Of the total cases, 25 (1.2%) was due to herbicides and fungicides poisoning. Herbicides and fungicides poisoning cases were similar in both sexes (male cases were 16, 1.4% and female cases 9, 1.0%). Among the total cases, 98 (4.7%) was due to snakebite poisoning. Snakebite poisoning cases was same in both sexes, 49 (4.2%) in males and 49 (5.4%) in females.

Out of the total poisoning cases, 162 (7.8%) deaths were reported during the study period. Of these deaths, 107 (66.0%) deaths were occurred in males and 55 (34.0%) deaths were in females. Male deaths 107 (9.1% of total male cases) was significantly higher than female deaths 55 (6.1% of female cases). Of the deaths, 57 (35.2%) deaths were due to organophosphorus and carbamate insecticides poisoning. Case fatality due to organophosphorus and carbamate insecticides poisoning was 13.8%.

Most of the deaths occurred due to the toxic effects of substances chiefly nonmedical as to source. Highest cases fatality was occurred due to the poisoning of toxic effects of substances chiefly nonmedical as to source shown in [Table 3].
Table 3: Type wise case fatality of poisoning reported in a teaching hospital during the period from April 1, 2005 to March 31, 2010


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Cases were more in males compared to females during the time period. Most of the deaths occurred during the period from April 1, 2008 to March 31, 2009 as shown in [Figure 1].
Figure 1: Sex wise trend of poisoning cases reported in a teaching hospital during the period from April 1, 2005 to March 31, 2010


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Case fatality was increasing according to the age increases. Case fatality was least in the age group of 0-15 years as shown in [Figure 2].
Figure 2: Age wise case fatality due to poisoning during the period from April 1, 2005 to March 31, 2010


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  Discussion Top


Pesticide poisoning is a major public health problem in developing world. [12] Intentional self-poisoning was the major cause of death due to poisoning. [13],[14] A study report mentioned that 2 million cases of poisoning was reported in each year with 200,000 deaths. [12] Many studies also showed that intentional self-poisoning has a higher mortality than accidental poisoning. [15],[16],[17],[18]

Kraits are nocturnal in habit. They enter human dwellings during the night in search of prey such as rats, mice, and lizards. The peak incidence of snakebite cases is reported during the paddy sowing and harvesting periods, June to November. The common krait, Bungarus caeruleus, is considered as the most dangerous species of venomous snake in the Indian subcontinent. [19]

A study by Ramesha et al. noted the incidence due to poisoning was more common among males (75.4%) than females (24.3). [20] However, another study showed that it was more among females (52.3%) than males (47.7%). [21] Similar results were found in other studies carried out in other centers. [22],[23],[24],[25],[26],[27],[28],[29],[30] However, one study mentioned that childhood poisoning was more among males than females. [27] The present study also showed that childhood poisoning was more among males (56.6%) than females (43.4%).

According to Khadka and Khadka study, most of the cases were found in the age group 21-30 years. [21] Another study reported that most of the acute poisoning cases were reported in the age group 20-29 years (31.2%), followed by the age group of 12-19 years (30.2%). [20] In present study most of the cases were reported in the age group of 26-45 years (30.7%), 18% cases were reported in the age group of 16-25 years, and 24.9% cases were reported in the age group of 0-15 years.

Majority of poisoning cases were due to organophosphorus compound (OPC) (36.0%). [20] Report of a study showed that 67.8% of poisoning cases was due to aluminum phosphide. [31] Ramesha et al. mentioned that majority of the poisoning cases (36.0%) were due to OPC. [20] Result of this study in Pondicherry showed an increasing trend of OPC poisoning over 3 years period. [32] Other studies showed that OPC are the most commonly used poisoning substances. [33],[34] Several studies reported that organophosphorus was the most commonly used poison. [22],[23],[26],[27] In the present study, 19.8% of total cases was due to organophosphorus and carbamate insecticides poisoning. This difference may be found because of a lesser amount of organophosphorus compound usage in Kerala compared to Karnataka.

A study revealed that 63% of poisoning cases was due to a plant called "Oduvan," and 2.2% was due to agrochemicals. [31] A study reported that 18% of the poisoning cases were due to drugs. [35] In the present study, 20% of poisoning cases occurred due to poisoning by drugs, medicaments and biological substances.

The result of pattern and outcome of the acute poisoning cases study indicated that the second leading type of poisoning was snake bite (16.2%). [20] In the present study 4.7% of cases were due to snakebite poisoning.

A recent study demonstrated that 14% of all deaths amongst 10-50-year-old women in Bangladesh were due to poisoning. [36] In the present study, case fatality due to poisoning was 7.8%. Of these deaths, 66.0% deaths occurred in males and 34.0% deaths were among females.

Many studies mentioned that most of the poisonous deaths were due to organophosphate (OP) pesticides. [14] OP pesticides were responsible for the majority of deaths in most series of self-poisoning cases. [37] In the present study, 35.2% deaths were due to organophosphorus and carbamate insecticides poisoning. Case fatality due to organophosphorus and carbamate insecticides poisoning was 13.8%.


  Conclusion Top


This study pointed out the fact that most of the cases were reported in the reproductive age group.

 
  References Top

1.
All India Student′s Association. Endosulfan: Government and the Pesticide Industry Orchestrating Genocide. The Voice of the Radical Students′ Movement. Available from: http://www.aisa.in/endosulfan-government-and-the-pesticide-industry-orchestrating-genocide/. [Last accessed on 2011 Jun 12].  Back to cited text no. 1
    
2.
David G, Michael E, Michael RP, Flemming K. The global distribution of fatal pesticide self-poisoning: Systematic review. BMC Public Health 2007;7:357.  Back to cited text no. 2
    
3.
Murray CJ, Lopez AD. The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Global Burden of Disease and Injury Series. Vol. 1. Cambridge, MA: Harvard School of Public Health; 1996.  Back to cited text no. 3
    
4.
Dey S, Dey I, Das B, Ghosh D. Epidemiology of oesophageal stricture and its outcome: A study among patients attending a tertiary hospital of Kolkata. Al Ameen J Med Sci 2013;6:176-9.  Back to cited text no. 4
    
5.
Hawton K. Deliberate self-harm. Medicine 1997;24:77-80.  Back to cited text no. 5
    
6.
Hawton K, Catalan J. Attempted Suicide: A Practical Guide to its Nature and Management. Oxford: Oxford Medical Publications; 1987.  Back to cited text no. 6
    
7.
Abu Ragheb S, Qaryoute S, el-Muhtaseb H. Mortality of burn injuries in Jordan. Burns Incl Therm Inj 1984;10:439-43.  Back to cited text no. 7
    
8.
Williams H, Buchan T. A preliminary investigation into parasuicide in Salisbury, Zimbabwe-1979/1980. Cent Afr J Med 1981;27:129-35.  Back to cited text no. 8
    
9.
Kanchan T, Menezes RG. Suicidal poisoning in Southern India: Gender differences. J Forensic Leg Med 2008;15:7-14.  Back to cited text no. 9
    
10.
Banejee RN. Poisonous snakes and their venoms, symptomatology and treatment. In: Ahuja MM, editor. Progress in Clinical Medicine, Second Series. India: Heinemann; 2003. p. 136-79.  Back to cited text no. 10
    
11.
Warrell DA. International Panel of Experts. The clinical management of snake bites in the South Asian region. Southeast Asian J Trop Med Public Health 1999;1:1-84.   Back to cited text no. 11
    
12.
Jeyaratnam J. Acute pesticide poisoning: A major global health problem. World Health Stat Q 1990;43:139-44.  Back to cited text no. 12
    
13.
Van der Hoek W, Konradsen F, Athukorala K, Wanigadewa T. Pesticide poisoning: A major health problem in Sri Lanka. Soc Sci Med 1998;46:495-504.  Back to cited text no. 13
    
14.
Eddleston M, Sheriff MH, Hawton K. Deliberate self harm in Sri Lanka: An overlooked tragedy in the developing world. BMJ 1998;317:133-5.  Back to cited text no. 14
    
15.
Hettiarachchi J, Kodithuwakku GC. Pattern of poisoning in rural Sri Lanka. Int J Epidemiol 1989;18:418-22.  Back to cited text no. 15
    
16.
Ingianna J, Herrero R, Albertazzi C. Comparative study of cases of poisoning by organophosphorous insecticides in various regions of Costa Rica. Rev Biol Trop 1983;31:139-44.  Back to cited text no. 16
    
17.
De Silva P. The logic of attempted suicide and its linkage with human emotions-Suicide in Sri Lanka, Kandy, Institute of Fundamental Studies, 1989;1:25-40.  Back to cited text no. 17
    
18.
Prajapati K, Merchant SP, Patel PR.. Trends of Suicidal Poisoning In Ahmedabad (Retrospective Study). NHL J Med Sci 2012;1:18-22.  Back to cited text no. 18
    
19.
Theakston RD, Phillips RE, Warrell DA, Galagedera Y, Abeysekera DT, Dissanayaka P, et al. Envenoming by the common krait (Bungarus caeruleus) and Sri Lankan cobra (Naja naja naja): Efficacy and complications of therapy with Haffkine antivenom. Trans R Soc Trop Med Hyg 1990;84:301-8.  Back to cited text no. 19
    
20.
Ramesha KN, Rao KB, Kumar GS. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India. Indian J Crit Care Med 2009;13:152-5.  Back to cited text no. 20
[PUBMED]  Medknow Journal  
21.
Khadka SB, Khadka SB. A study of poisoning cases in emergency Kathmandu Medical College Teaching Hospital. Kathmandu Univ Med J 2005;3:388-91.  Back to cited text no. 21
    
22.
Urmila B, Bahadur SJ, Madhusudan S. Study of acute poisoning in Nepal Medical College Teaching Hospital. Nepal Med Coll J 2000-2001;2:83-5.  Back to cited text no. 22
    
23.
Prasad PN, Prakash K. Poisoning cases at TUTH emergency - A one-year review. J Inst Med 1997;19:18-24.  Back to cited text no. 23
    
24.
Abdollahi M, Jalali N, Sabzevari O, Hoseini R, Ghanea T. A retrospective study of poisoning in Tehran. J Toxicol Clin Toxicol 1997;35:387-93.  Back to cited text no. 24
    
25.
Kumar GS, Prasad JM. Pesticide poisoning cases attending fiver major Hospital of Nepal. J Nepal Med Assoc 2002;41:447-56.  Back to cited text no. 25
    
26.
Kafle KK, Kumar G. Organophosphorous - Commonest poisoning agent. J Inst Med 1992;14:228-33.  Back to cited text no. 26
    
27.
Man SB. Childhood poisoning analysis & review. J Inst Med 1991;13:243-56.  Back to cited text no. 27
    
28.
Khadka SB, Ale SB. A study of poisoning cases in emergency Kathmandu Medical College Teaching Hospital. Kathmandu Uni Med J 2005;3:388-91.  Back to cited text no. 28
    
29.
Lohani SP, Krishna BH. An epidemiological study on acute pyrethroid poisoning. Nepal Med Coll J 2001;3:36-9.  Back to cited text no. 29
    
30.
Thapa SR, Lama P, Karki N, Khadka SB. Pattern of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital. Kathmandu University Medical Journal 2008;6:209-13.  Back to cited text no. 30
    
31.
Siwach SB, Gupta A. The profile of acute poisonings in Harayana-Rohtak Study. J Assoc Physicians India 1995;43:756-9.  Back to cited text no. 31
    
32.
Basu A. Study of Organophosphorus poisoning over 3 years. J Assoc Physicians India 1988;36:21.  Back to cited text no. 32
    
33.
Unnikrishnan B, Singh B, Rajeev A. Trends of acute poisoning in south Karnataka. Kathmandu Univ Med J 2005;3:149-54.  Back to cited text no. 33
    
34.
Thomas M, Anandan S, Kuruvilla PJ, Singh PR, David S. Profile of hospital admissions following acute poisoning - Experiences from a major teaching hospital in South India. Adverse Drug React Toxicol Rev 2000;19:313-7.  Back to cited text no. 34
    
35.
Das RK. Epidemiology of Insecticide poisoining at A.I.I.M.S Emergency Services and role of its detection by gas liquid chromatography in diagnosis. Med Update 2007;7:49-60.  Back to cited text no. 35
    
36.
Yusuf HR, Akhter HH, Rahman MH, Chowdhury MK, Rochat RW. Injury-related deaths amongst women aged 10-50 years in Bangladesh, 1996-97. Lancet 2000;355:1220-4.  Back to cited text no. 36
    
37.
Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM 2000;93:715-31.  Back to cited text no. 37
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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