Assessment of Poisoning Cases in a Tertiary Care Hospital

Background: Poisoning isacommonday-to-dayevent. It is important to know the nature, severity and outcome of acute poisoning cases in order to take up appropriate planning, prevention and management techniques. Objective : The objective of this study was to assess the poisoning cases admitted to the tertiary care hospital, VIMS, BELLARY. Materials and Methods: Data from case records of 100 patients admitted with the diagnosis of acute poisoning during 6 months were collected. Information demographic features, name of poisonous substances, mode of poisoning, time elapsed after intake, mode of treatment given, duration of hospitalization, severity and outcome was collected in the prestructured proforma and subjected to statistical analysis. Results: Out of 100 study subjects, 48 were males and 52 Females, 21-30 years of age group is more among males compared to females. The most common type of poisoning is OP Poisoning 58%. After treatment 76% recovered and 24% were discharged against medical advice. Only 21% had developed complications. The relation between age, locality, marital status, SES mode of poisoning outcome, duration of hospital stay and type of poisoning are found to be statistically significant. Conclusion: OP poisoning cases accounts for majority of the admission. Appropriate emergency care is being given inspite of the delay in transit to the hospital .


Modes of poisoning:
The most common type of poisoning is OP Poisoning (58%) as shown in Fig no 2. Among these 79% are suicidal cases, most common route of poisoning being oral (79%). 33% of the study subjects had precipitating factors among which depression (20%) was the leading precipitating factor as shown in Fig no.3.

Fig No 3: Shows precipitating factors.
Majority of the patients were visited the hospital for the treatment after 3 to 4 hrs of poisoning (46%) as shown in After treatment 76% recovered and 24% were discharged against medical advice. Only 21% had developed complications. Most common complication is the respiratory depression observed in 11% followed by cellulitis (8%) mainly in cases of snake bite and inte rmediate syndrome (2%).
The mean duration of the hospital stay of the 48% patients were 3-5 days and there was statistical significant association between the type of the poisoning and outcome (p<0.001) as shown in

Discussion
Poisoning is one of the leading causes of morbidity and mortality .The WHO reports suggest pesticides are now most common met hod of suicide worldwide. In our study out of the 100 cases, 79 of them were suicidal in nature which was similar to the other studies done by Maharani et al. and Shoaib et al. 7,8 48% of them were male and 52% were female which was similar to studies done in Nepal but studies done in Tamil Nadu and other parts of Karnataka showed incidence was more among males compared to females 4,7 . It can be attributed to early marriage in the rural community along with its added familial responsibilities, social custom, limited resources. The most common type of poisoning was OP compound poisoning (58%) similar to the results of other studies done in southern India and Nepal in contrast to studies done in North India which showed most common poisoning is Alu minium phosphide. [8][9][10][11] which relates to the availability of compounds. The most common age group affected was 21-30 yrs of age group which was similar to most of the other studies conducted 7-9. which can be explained by the fact that the persons of this age suffer from stress of the modern lifestyles, failure in love, family problems, nuclear family concept etc.33% of the study subject had precipitating factor most common being depression which was simila r to the studies of Ramesh et al. 3 Most of the population were from rural area 53% ,it was similar to other studies. Most of them were labourers (55%) by occupation this can be explained by poverty, inadequate income to run the family, monsoon failure leading to stress and depression. Majority were married (71%), factors like dowry, cruelty by the in-laws, family quarrels, maladjustment in married life are responsible for the higher incidence of poisoning among house wives which was in consistent with other study result. 3,9 Most of them arrived to the hospital after 3-5 hrs of consumption similar to other study result 9 ,which attributes to the trying with local level management and then referral to higher centre or inability to reach medical care to the periphery. Majority of the cases treated adequately with pharmacological and non pharmacological treatment. Most common complication encountered in OP poisoning was respiratory depression (11%) and requirement of ventilation which was similar to other study by Vaidyanathan et al.where31.8% of patients required ventilator support. 11 Mean duration of the hospital stay was 3-5 days similar to the results of Ramanatha et al. 12 that time is normally required for close monitoring and complete observation of the poisoning cases. Most of them were treated adequately and recovered and discharged(76%) similar results of other study. 9 This accounts for the proper management in tertiary care set up inspite of delay in the transit time in seeking medical help.

Conclusion
In a tertiary care centers like ours, in 100 poisoning cases recorded it was found that majority of middle aged married women of low SES are prone to suicides predominantly with insecticides, particularly OP compounds. Out of 80% of poisoning cases referre d and admitted in tertiary care centre, 76% of cases received the treatment which included Atropine and PAM and surgical intervention like tracheostomy, fasciotomy a nd recovered fully well. This highlights the appropriate emergency care in spite of the delay in transit.
The relatively small sample size, retrospective record-based nature is the limitations of our study. The information such as miscellaneous poisoning and types of snakes was not there in the records for analysis. Overall, the study contributes substantial additional information regarding the epidemiology and outcome of poisoning in a tertiary care teaching hospital at a district level.