|Year : 2015 | Volume
| Issue : 3 | Page : 156-160
A profile of acute poisonings: A retrospective study
Thalappillil Mathew Celine, Jimmy Antony
Department of Community Medicine, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India
|Date of Web Publication||16-Sep-2015|
Asso. Prof. Thalappillil Mathew Celine
Department of Community Medicine, MOSC Medical College, Kolenchery, Ernakulam, Kerala
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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. 
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.  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 , 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.  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. ,,,
Intentional self-poisoning due to organophosphorus is very high in the southern region of India because it easily available in these regions.  Snakebite poisoning is another common type of poisoning among people in rural areas at the time of wet weather and rainy season.  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.  The aim of the study was to characterize the poisoning cases and related mortality among patients admitted with poisoning.
| Materials and Methods|| |
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.
Microsoft excel was used for the analyzing the data. Frequency distributions and case fatality rates were analyzed.
| Result|| |
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|| |
Pesticide poisoning is a major public health problem in developing world.  Intentional self-poisoning was the major cause of death due to poisoning. , A study report mentioned that 2 million cases of poisoning was reported in each year with 200,000 deaths.  Many studies also showed that intentional self-poisoning has a higher mortality than accidental poisoning. ,,,
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. 
A study by Ramesha et al. noted the incidence due to poisoning was more common among males (75.4%) than females (24.3).  However, another study showed that it was more among females (52.3%) than males (47.7%).  Similar results were found in other studies carried out in other centers. ,,,,,,,, However, one study mentioned that childhood poisoning was more among males than females.  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.  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%).  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%).  Report of a study showed that 67.8% of poisoning cases was due to aluminum phosphide.  Ramesha et al. mentioned that majority of the poisoning cases (36.0%) were due to OPC.  Result of this study in Pondicherry showed an increasing trend of OPC poisoning over 3 years period.  Other studies showed that OPC are the most commonly used poisoning substances. , Several studies reported that organophosphorus was the most commonly used poison. ,,, 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.  A study reported that 18% of the poisoning cases were due to drugs.  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%).  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.  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.  OP pesticides were responsible for the majority of deaths in most series of self-poisoning cases.  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|| |
This study pointed out the fact that most of the cases were reported in the reproductive age group.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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