K Rajender Kumar

Abstract

Introduction: Poisoning with various substances is an important cause of death and disability worldwide. The types of poisons that are encountered in the emergency medicine departments encompass a wide range of substances. Apparently, geographic location, socio-demographic factors, ease of availability of poisons and many other cryptic factors contribute to the wide spectrum of substances that cause poisoning. Pesticides, drugs and chemicals are reported to be the most commonly used poisons in India. Management of poisoning is quite challenging for the health care professionals globally. Factors such as the uncertainty in the identification of allegedly consumed poison, varied clinical features and the need for timely access to specific information for treatment, complicates poisoning management. Aim: This study was therefore conducted to explore the clinical features, management and outcomes of poisoning cases reporting to a tertiary care centre in Hyderabad. Methods & Results: The present study was undertaken to evaluate the pattern of poisoning deaths in Hyderabad region of Telangana. The Paper presents the study of 271 cases of poisoning during the span of three years from 01/04/2016 to 31/03/2018. Out of 1841 Post mortem examination done during the study period 271 cases were of poisoning. Among the poison cases carbamate insecticide accounted for 21 cases (7.74%). The cases were then analyzed on various parameters in the pro forma prepared for this purpose. We concluded that majority of victims were married, different religions males from rural area and low socioeconomic group. The incidence of poisoning was more common during 21-30years of life. Suicidal cases were more common than accidental cases. Few case of homicidal poisoning was detected in present study, chemical analysis of viscera done in cases. Conclusion: Carbamate poisoning was the most common type of poisoning. Several chemicals like Lannate, Baygon, Temik, Sevian and Isolanwere used with suicidal intention. There were no casualties. Timely management of poisoning according to evidence based guidelines potentially minimises morbidity and mortality due to poisons and helps improve patient outcomes. Keywords: Tachycardia, pulmonary oedema Lannate, Baygon, Temik, Sevian and Isolanwere

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Abstract

Introduction: Nowadays, organophosphate (OP) compounds are widely used in agricultural field as an insecticide. Toxicity with these compounds is owing to inhibition of acetylcholinesterase enzyme. Patients are presented with muscarinic and nicotinic side effects. Objective: To study the clinical aspect of OP poisoning in detail with hospital stay, clinical course, complication, and recovery and mortality in OP poisoning. Materials and Methods: This study was done at Gandhi Medical College and in association with ayan Institute of Medical Sciences, Hyderabad India, comprising 271 cases of OP poisoning. After taking written consent, personal history of the patients was taken. Then, a detailed history regarding poison and clinical symptoms was taken. Then, general and systematic examinations of patients were carried out, and blood samples were sent for investigations. We followed up the patients till discharge or death. Result: In our study, maximum incidence of OP poisoning was in between 21-30   years age group (40%), and male to female ratio was 4:1. Clinical symptoms such as unconsciousness, stupor (90.47%), vomiting (9.42%), convulsions (66.00%) are froth at mouth and nostrils (62.00%) and the common symptoms whereas constricted pupils (85.71%), pulmonary oedema (88.00%), Tachycardia (76.17%), hypotension (28.57%)are the common signs noted in this series of cases who were treated in the hospital and where the hospital records were available. Post-mortem appearances no specific anatomic changes are found in acute poisoning the changes are suggestive os asphyxia. The appearances are external or internal. The histopathological findings are not significant. Histopathological examination of tissue revealed usually congestion of brain, oedema and congestion of lungs and fatty degeneration in liver and in some cases cloudy swelling and tubular necrosis in kidneys. Conclusion: Detailed history and thorough clinical examination of patients are helpful in diagnosing the patients of OP poisoning. Life-threatening complications occurred in these patients. Early detection and immediate treatment in intensive care units with injections atropine and PAM can increase the chances of survival rate of patients. Keywords: Tachycardia, pulmonary oedema

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