Pattern of poisoning: Experience at tertiary care hospital

 

N Naveen^1*, A Edwin Joe², R N Kagne³

 

¹Assistant Professor, Chengalpattu Government Medical College and Hospital, Chengalpattu, Tamil Nadu.

²Professor, Department of Forensic Medicine and Dean, Thoothukudi Government Medical College and Hospital, Thoothukudi, Tamil Nadu.

 

Abstract               Background: Pattern of poisoning in a region depends on variety of factors like availability and accessibility of poison, socioeconomic status of the population and impact of culture. Knowing the pattern of poisoning cases in a region helps in suggesting proper earliest preventive measures and also in early management of cases. Aim: To determine pattern of poisoning of cases which will be helpful to plan and implement strategies towards prevention of poisoning. Material and Methods: A total of 615 cases with history of poisoning were studied. History about the poisoning regarding, time, date, type of poison, manner of poison, route of administration, time elapsed in hospital admission and prognosis of poisoning were recorded in the proforma. Results: In poison consumption cases most common manner of poisoning was suicidal in nature i.e. 253 cases (41.1%) followed by accidental i.e. 69 cases (11.2%). Most of the cases were reported in the morning hours i.e., 177 cases (28.8%) and in the month of July i.e., 65 cases (10.6%). In poison consumption cases, the most common route of poisoning is ingestion 313 cases (50.9%), skin contacts 5 cases (0.8%) and inhalation 4 cases (0.7%). Whereas in bites and stings were by parenteral route 293 cases (47.7%). Conclusion: Government authorities and planning bodies need to organize mass education programs to create awareness and stress the significance of a proper history to minimize the mortality due to poisoning.

Keywords: Pattern of poisoning, suicidal, ingestion, bites and stings

 

 

INTRODUCTION

Poison is any substance irrespective of its quality or quantity when given with an intention to endanger, injure or kill a person.¹ In India intentional, occupational and accidental poisoning is a major public health problem.² Manner of poisoning is mainly suicidal and accidental, whereas even few cases of homicide are reported.³ Poisoning and hanging are the two major modes of suicides in India. During 2013, in Puducherry region, the suicidal rate was 35.6 per one lakh populations and suicidal poisoning deaths were 12.3%, whereas the accidental poisoning deaths were 2%.⁴ In India most common poison consumed are pesticides, sedative drugs, plant toxins, chemicals and household poisons.^5-8 Among children kerosene, house hold chemicals, plant toxin, drugs and pesticide are more common.^9,10 Accidental case of poisoning is due to various stings and bites. In India about 10,000 snake bite deaths¹¹ and 1.2 million cases of scorpion stings were reported annually every year.¹² Pattern of poisoning in a region depends on variety of factors like availability and accessibility of poison, socioeconomic status of the population and impact of culture.³ It also varies from country to country and from one place to the other.¹³ Knowing the pattern of poisoning cases in a region helps in suggesting proper earliest preventive measures and also in early management of cases.³ Modern toxicology played a major role in early diagnosis, treatment and detection of poison. Information gathered from this study can be used in formulating regulations which will help society from the hazardous effects of poisoning. This study was carried out at determining pattern of poisoning of cases which will be helpful for the government authorities and planning bodies, to plan and implement strategies towards prevention of poisoning.

MATERIAL AND METHODS

The present study was conducted in the Department of Casualty and Forensic Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry after obtaining approval from Institutional Ethical Committee. Sample size: The number of poisoning cases reported to casualty during study period were 760, which comprises 30% of all the medico legal cases. So, with this 30% as P, with the precision of 5% and design effect of 2, the sample size will be approximately 470. So, all poisoning cases were taken up for study during the study period. Inclusion criteria: All the cases who had consumed poison or victims of bites and stings, reported to casualty, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, during the study period were included. Exclusion criteria: Poisoning cases treated elsewhere before reporting to Casualty, Sri Manakula Vinayagar Medical College and Hospital, Puducherry. Methodology: When the person arrived to the casualty with the history of poisoning initial management was done. Once the poisoned person was stabilized, the patient information sheet both in Tamil and English were issued to the patient or relative’s which contained all the information regarding the study. Consent was then obtained from the patient himself or relatives. The victims profile like name, age, sex, marital status, education and occupational status were obtained and two identification marks were recorded. History about the poisoning regarding, time, date, type of poison, manner of poison, route of administration, time elapsed in hospital admission and prognosis of poisoning were recorded in the proforma. Statistical analysis: Data collected was entered in the computer database, analysis done using EpiInfo software version 3.4.3.

 

RESULTS

In this present study of total 615 poisoning cases, Maximum number of cases were in age group of 21-30 years i.e. 178 cases (28.94%), followed by 11-20 years i.e. 126 cases (20.49%) and least incidence was found in age group > 70 years i.e. 6 cases (0.98%). Maximum number of male and female victims were observed between 21-30 years i.e. 80 cases (13.2%) and 98 cases (15.9%) respectively. In poisoning consumption cases as well as bites and stings cases maximum number of male female distribution was observed in the same age group. Out of 615 cases, accidental poisoning was reported in 362 cases (58.9%) and suicidal poisoning was reported in 253 cases (41.1%), but not a single case of homicidal poisoning was reported.

The most common type of poisoning is insecticide and pesticide i.e. 135 cases (22.2%), followed by unknown bites 101 cases (16.4%) and scorpion sting 96 cases (15.6%). In suicidal victims the most common poison consumed was insecticides and pesticides 124 cases (20.1%), followed by poisonous plants 57 cases (9.2%) and drug overdose 36 cases (5.9%). The maximum number of accidental poisoning cases were of unknown bites 101 cases (16.5%) followed by scorpion sting 96 cases (15.6%) and snake bite 53 cases (8.7%). The least common type of poison in accidental poisoning is by consuming poisonous plant 2 cases (0.3%) and drug overdose 2 cases (0.3%). In poison consumption cases, the most common route of poisoning is ingestion 313 cases (50.9%), skin contacts 5 cases (0.8%) and inhalation 4 cases (0.7%). Whereas in bites and stings were by parentral route 293 cases (47.7%). In the present study maximum 280 cases (45.5%) were admitted within 1 hour of poisoning of which 109 cases were of consumption and 171 cases were of bites and stings. Whereas 226 cases (36.7%) were admitted with the delay of more than one hour but within 4 hours of which 142 cases were of consumption and 84 cases were of bites and stings. Only 17.7% of cases were reported for hospitalisation with a delay of more than 4 hours.

DISCUSSION

The pattern and magnitude of poisoning are multidimensional and demand multi-faceted approach for facing this problem. In this hospital based descriptive study a total of 615 cases with history of poisoning were analysed.        The most commonly affected age group was 21-30 years (28.94%). It was observed that this age group was affected in most of the studies.^1,2,14 The second commonest age group affected was 11-20 years (20.49%). The least affected were of age more than 70 years (0.98%). This finding correlates with study conducted by Santhosh CS et al ,² Kumar NH et al ,¹⁵ Padmakumar K et al .¹⁶ This may be due to stress, failure in love or examinations, family problems, modified life style and peer pressure at this age group. The incident of cases was more common in the morning i.e., 177 cases (28.8%), followed by evening (28.5%) and then night (24.6%). Bharath k et al ,¹⁷ Palimar V et al ¹⁸ conducted a study in which incidence is more in morning similar to that of present study. Padmakumar et al¹⁶ Haloi M et al¹⁹ Vijaykumar AG et al²⁰ studies reported that incidence is more in the night which contradicts to the present study. Most of the cases occurred in the month of July which is similar to the study conducted by Padmakumar K et al ,¹⁶ Haloi M et al .¹⁹ Vijaykumar AG et al²⁰ observed that June month is most common. Navinkumar M et al ²¹ observed that September is the commonest month, June, July, August, September has highest incident of poisoning cases because this is the month for farming activity and easy availability of poisons since India is an agriculture based country major people depend on farming. The bites and stings are common due to rainy season. Majority are accidental victims 362 cases (58.9%), followed by suicidal 253 cases (41.1%) and no homicidal deaths are reported. Suicidal cases are more in females than males and accidental cases are more in males than females. This study correlates with the study conducted by Ansam F et al .²² Study conducted by Kshirsagar VY et al ,²³ Gargi et al ²⁴ are consistent with the present study that accidental cases are more common than suicidal. Some studies contradicts to the present study that suicidal victims are more common than accidental cases.^15,25,26 No homicidal cases were reported in this present study which is similar to most studies^14,17 and contradictory to few studies.^2,16,19 The accidental cases are more common may be because there is lack of knowledge and education among the population where the study was conducted. The most common poisoning was insecticides and pesticides 135 cases (22.2%). Most studies reported similar results.^2,17,20,21 In accidental cases the present study reports that unknown bite 101 cases (16.4%) is common which contradicts to the study conducted by Singh S et al ,²⁷ Patil D et al ,²⁸ Vaidya YP et al ²⁹ and Tapse SP et al ³⁰ that snake bite is more common. The most common mode of poisoning is ingestion 313 cases (50.9%), followed by parenteral 293 cases (47.6%). Similarly most studies report that ingestion is the most common route of administration.^16,17,21 This is common probably because it is the easy mode of administration. In present study, time elapsed in poisoning and hospital admission is maximum within 1 hour 280 cases (45.6%) and 1-4 hours 226 cases (36.7%). This correlates with study conducted by Bharath K et al ,¹⁶ Rohit C et al ³¹ which shows maximum time elapsed is 1-4 hours and Ramesha KN et al  shows maximum time elapsed within 2 hours.³²

 

CONCLUSION

Government authorities and planning bodies need to organize mass education programs to create awareness and stress the significance of a proper history to minimize the mortality due to poisoning. Awareness regarding poisons handling and poisonous substances to the general public through various means can reduce the incidence of poisoning.

 

 

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