Changing spectrum of acute poisoning in North India: A hospital-based descriptive study
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Keywords: Acute poisoning, case fatality, drug overdose, herbicide, opioid, paraquat, pesticide
OBJECTIVES: Evaluating local trends and continued monitoring of patterns of acute poisoning are essential for prompt recognition of the toxidromes, the establishment of immediate treatment facilities (e.g., antidote availability), and effective preventive strategies (e.g., governmental regulation on hazardous substances marketing). We aimed to describe the prevalence of the various types of poisoning and associated case fatality in our academic hospital in North India.
METHODS: A prospective observational descriptive study was conducted, enrolling patients aged ≥13 years with acute poisoning for 17 months from December 2016 to December 2017 and from September 2019 to December 2019, for a total of 17 months.
RESULTS: Four hundred and two patients were enrolled (median age 28 years; 63.2% males). Majority of the acute poisoning cases resulted from ingestion (n = 391, 97.3%) and the primary intention was most commonly self-harm (n = 314, 78.1%). The major types of poisoning were pesticide (n = 264, 65.7%), drug overdose (n = 77, 19.2%), and corrosive ingestion (n = 31, 7.7%). Pesticides included insecticides (n = 146, 36.3%; cholinesterase inhibitors, n = 91), fungicides (n = 76, 18.9%; all aluminum phosphide), herbicides (n = 22, 5.5%; paraquat, n = 19), and rodenticides (n = 20, 5.0%; coumarin derived substances, n = 12). Benzodiazepines (n = 33) and opioids (n = 25) were frequent causes of drug overdose. 95.3% (n = 379) received preliminary treatment at the previous health-care center, including gastric lavage (n = 239) and antidotes (n = 73). In hospital case fatality rate was 17.3% (n = 58).
CONCLUSION: Herbicide ingestion and opioid overdose are emerging threats with a gradual decline in organophosphate and aluminum phosphide poisoning. Despite improving management of acute poisoning, the overall case fatality rate remains substantial.
How to cite this article: Pannu AK, Bhalla A, Vamshi V, Upadhyay MK, Sharma N, Kumar S. Changing spectrum of acute poisoning in North India: A hospital-based descriptive study. Turk J Emerg Med 2022;22:192-9.
The Institutional Ethics Committee of Postgraduate Institute of Medical Education and Research, Chandigarh (India) approved the study (No. INT/IEC/2017/1450, date March 10, 2016).
AKP: Conceptualization (supporting); Formal analysis (lead); Writing‑original draft (lead); Writing‑review and editing (lead).
AB: Conceptualization (lead); Methodology (lead); Writing‑review and editing (supporting).
VV: Data curation (lead); Formal analysis (supporting).
MKU: Data curation (supporting); Formal analysis (supporting); Writing‑original draft (supporting).
NS: Conceptualization (supporting); Methodology (supporting).
SK: Conceptualization (supporting); Methodology (supporting).
The corresponding author is responsible for ensuring that the descriptions are accurate and agreed upon by all authors.
The authors would like to thank Mrs. Sunaina Verma for her help in statistics.