A study of pattern and outcome of patients
admitted with Acute Poisoning in the
Medical wards in Medical College,
Thiruvananthapuram
Dr. Aswinikumar S* and Anu Mariam Thomas$
* Professor, Department of Internal Medicine, Govt. Medical College, Thiruvananthapuram.
$ M.B.B.S. Student, Medical College, Thiruvananthapuram, 2010 Batch.
Abstract
This study aims to estimate the prevalence of the different methods commonly adopted for
poisoning and to find out the association between the types of poison used and different sociodemographic variables. The study was conducted in the Medical wards of Govt. Medical College,
Thiruvananthapuram. During a period of one month a total of 106 patients admitted in the medical
wards with acute poisoning were interviewed with the help of a pre-structured proforma. The data thus
obtained was analyzed using appropriate descriptive and inferential statistical techniques.The incidence
of poisoning was found to be almost similar among males and females (males-48%, females-52%). Young
adults in the age range of 21-40 years constituted the majority (55.7%). The most common substance
used was pharmaceutical products (34.9%), followed by rat poison (18.9%) and organophosphates
(14.2%). Morbidity associated with poisoning (indicated by duration of hospitalization) was significantly
associated with the intake of organophosphate and rat poison (χ2= 43.956; p<0.001). Males were found
to take such poisons more frequently than females (χ2=24.483; p<0.001).The most common reason for
selection of a particular poison was easy availability (72.1%) followed by low cost (20.2%). Accidental
poisoning was more common among older age group (41 years and above; χ2 = 6.683; p< 0.05).In
almost all cases admitted with acute poisoning, the poison was ingested with the intention of suicide.
Educated young adults constituted the major group admitted with acute poisoning. The study indicated
that the incidence of poisoning could be reduced by restricting the availability of poisonous substances.
Introduction
Poisoning, which amounts to 33% of all suicide deaths in India, is ranked first among the different means
of suicide, closely followed by hanging (31.4%).
Suicide rate in India is slightly above the world rate. It has been reported that more than one lakh
persons in our country committed suicide during the year 2010. In the past one decade, the suicide rate
has increased from 10.8 to 11.4 per 100,000 (National Crime Records Bureau, 2010). A large proportion
of suicide deaths have been found to occur between the ages of 15 and 29 years, especially in women
(Patel et al., 2012). It is also noteworthy here that suicide attempters are ten times more than the
suicide completers (Patel et al., 2012).
Kerala boasts of a very high literacy rate of 93.9%, when the Indian average is only just 74.04%. Another
interesting fact about Kerala is that while the whole of India is heading towards a population explosion,
the population growth in Kerala is negative, which is similar to that seen in developed nations (India
Census, 2011). In spite of all these, Kerala also tops in number of suicides, which comes to about
25.5/lakh, the national average being only 10/lakh (National Crime Records Bureau, 2010; State Crime
Records Bureau, 2010).
This is a perplexing situation which has generated a lot of discussion and debate among social scientists
and policy makers. Media used to highlight the high suicide rate in Kerala, and also carry detailed stories
of individual cases of suicides. However, in‐depth studies of the causes of the problem had been very
rare. Similarly, less attention had been given to those who fail in their attempts to commit suicide. In
fact, the latter group constitutes a large chunk of people, who are in need of emotional and social
support. It is felt that knowledge regarding the pattern of acute cases of poisoning may be helpful in
developing effective intervention strategies. The present study was conceived in this context.
Aims and Objectives
1.
Estimate the prevalence of the different methods commonly adopted for poisoning among patients
admitted with poisoning in Medical College Hospital.
2.
Find out the association between the types of poison used and factors such as age, sex, occupation,
educational status etc.
3.
Find out the outcome of subjects of study within one week as relieved or dead.
Materials and Methods
Information regarding the relevant variables in the study was collected from the patients admitted to
the medical wards of Government Medical College Hospital(MCH), Thiruvananthapuram who were
willing to participate in the study. A total of 106 patients were thus included in the study during a
period of one month. The cases admitted to the medical wards were visited on the post admission day.
Patients’ relatives or bystanders were given a brief outline of the nature of the study and informed
consent for participation in the study was obtained from them. A questionnaire prepared for the
purpose of interviewing the subjects (Proforma) was used to collect and record the data. The proforma
helped the investigator to explore every case in detail and to collect relevant information from the
patients themselves/bystanders regarding the socio-economic background, the poison involved, family
history, etc.
Inclusion criteria:
All patients who are admitted to medical wards with acute poisoning, and who are willing to
participate in the study.
Exclusion criteria:
Patients who are critically ill and admitted directly to the intensive care unit (ICU).
Cases of bites (snake, dog, unknown etc.), stings, and food poisoning.
The short term outcome of the case till discharge of a case was noted as discharged, relieved or dead.
Analysis of data
Data obtained in the study was subjected to statistical analysis with Statistical Package for Social
Sciences (SPSS) to find out the nature and extent of relationships among the variables. The statistical
techniques included descriptive procedures like percentages, and inferential procedures like Chi‐square.
Results
Analyzing the sociodemographic characteristics of the sample obtained in the study (N=106), it
was found that the proportion of males and females were found to be almost similar (males-48%,
females-52%). Most cases of acute poisoning were found among young adults in the age range of 21- 40
years (55.7%), whereas in the younger and older age groups (below 20 years and above 40 years), the
incidence rate was similar and lower (21.7 and 22.6% respectively). By occupation, most (34.9%) were
unskilled labourers, followed by unemployed females (22.6%) and students (18.9%).
With regard to the nature and mode of poisoning, analysis of the data revealed the results
summarized table 1.
Table 1. Distribution of the sample based on type of poison used, mode of poison, and reason for
selection of poison.
Variable
Group
Organophosphate 15
14.2
Rat poison
20
18.9
Pharmaceutical
products
37
34.9
8
7.5
6
5.7
Plant poison+ rat 1
poison
0.9
Others
19
17.9
Accidental
9
8.5
Suicidal
97
91.5
74
71.2
21
20.2
9
8.7
Type of
Corrosive
poison
Plant poison
Mode of
poisoning
Frequency Percentage
Reason
Easy availability
for
Low cost
selection
of poison Accidental
It may be seen from table 1 that the substance commonly involved in poisoning was
pharmaceutical products (34.9%). This was followed by rat poison (18.9%) and organophosphates
(14.2%). Majority of the poisonings were found to be suicidal (91.5%) and the remaining were
accidental (8.5%). The most common cause for selection of a particular poison was easy availability
(72.1%). Low cost accounted for the selection of a particular poison in (20.2%) of cases.
Table 2 presents the information relating to the history of suicide attempts and psychiatric
illnesss in the patient and in the family.
Table 2.Information relating to the familial background of the patients.
Variable
Group
Frequency
Percentage
Yes
17
16
No
89
84
Yes
12
11.4
No
93
88.6
Yes
13
12.4
No
92
87.6
History of suicidal attempts?
Family history
attempts
of
suicidal
History of psychiatric illness in
the patient
Sixteen percent of cases of poisoning had a history of at least one attempt of suicide in the past.
A family history of suicidal attempts was present in 11.4% of cases. In 12.4% of cases, a history of
psychiatric illness was found to be present in the patient. A history of psychiatric illness was present in
the family in 10.5% of cases.
Significant difference was found between the types of poison used by males and females
(χ2=24.483; p<0.001). Organophosphates, rat poison, plant poison, and corrosives were used more
frequently by males than females, whereas, females tended to make more use of pharmaceutical
products, and other house-hold items. Reason for the choice of the substance used also varied
significantly with gender (χ2=8.919; p<0.05).
Discussion
It is interesting to note that the single most common substance involved in poisoning was
pharmaceutical products (35%). The study also revealed a gender difference in the choice of
substances, with preference for pharmaceutical products more pronounced among females (56%) than
among males (12%). Similar findings have been reported by researchers in other countries. For
example, a study by Afshari et al. (2004) in Iran found that pharmaceutical products were preferred by
63% of the subjects, while another study by Liminjdaporn (2010) in Thailand found it to be the most
common substance (38%). In both these studies, majority of suicide attempters were females. On the
other hand, Ramesha, Krishnamurthy and Kumar (2009), in a similar study conducted in Karnataka,
India, found that males were more in number and that the most common poisons used were
organophosphates and pesticides. This finding is also supported in the present study, in the sense that
organophosphates and rat poison were found to be the major types of poison used by males (47%).
Duration of hospital stay can be taken as an indication of severity of poisoning. In this sense,
organophosphate poisoning turned out to be the most dangerous. 46.7% of all those who had
consumed organophosphate had to stay in the hospital for a period of more than or equal to 8 days.
Srinivas et al. (2005), who studied on pesticide poisoning, reported that mortality was very high (23%)
among these cases. There are also several other studies which found that mortality was high when the
substance involved was pesticide (Ramesha, 2009; Liminjaporn, 2010)
The reasons for selection of a poison by suicide attempters could be classified into two, viz.,
easy availability and low cost. In general, the most common reason reported is easy availability (72.1%).
73.3% of all who consumed organophosphate selected it because of its easy availability at their location.
At the same time, 63.2% of cases who used rat poison cited low cost as the reason for their choice. This
highlights the importance of regulation in the marketing and accessibility of toxic substances. A study
on the influence of pesticide regulation on acute poisoning deaths in Sri Lanka (Darren et al., 2003)
points to the same fact.
Considering gender difference in the incidence rate of acute poisoning, it may be noted that
several studies from Asian countries have found it to be a significant variable. In the present study, the
incidence was found to be marginally higher among females (52%) compared to males (48%). Similar
findings have been reported by Howlader et al. (2008), and Kora (2011). In contrast to these findings,
Ramesha et al. (2009) found that majority of the cases of acute poisoning was among males (75.4%).
Higher incidence rate among males have been reported by other researchers also (e.g., Munidasa et al.,
2004; Srinivas et al., 2005; Heyerdahl et al., 2008; Omender, 2011).
In the case of difference between males and females in the type of poison used, it was found
that the males resort more to substances associated with higher rates of mortality like
organophosphates, rat poison, and corrosives, whereas females were found to go for relatively less
poisonous substances like pharmaceutical products and other house hold items. It may also be
interesting to note that majority of the females used substances that were available at hand in the
household, while males tended to use poisons bought from shops. This may be explained as due to the
difference in the roles played by males and females in the family, wherein the males go out more and
are more in control of money. Another reason may be the difference in the intent of poisoning among
males and females. Though it is difficult to ascertain whether a person consumed poison with the intent
of dying or not, the choice of the type of poison indicate that males commit the act with greater
planning and with the intent of dying. On the other hand, accidental poisoning was also found to be
more among males, especially among the higher age groups (above 40 years). This may be because of
higher incidence of work related accidents among older males who take on more hazardous jobs.
Treatment in wards consisted of non-specific supportive treatment in 60.8% of cases. Specific
antidotes for poisons were given in 39.2% of cases. Similar statistics relating to the treatment patterns
have been reported by Heyerdahl et al. (2008) and Catherine et al. (2012).
Conclusions
The study was helpful in identifying some of the social factors significantly related to the
relatively high incidence of suicide in Kerala. Analysis of the data obtained in the study lead to the
following conclusions:
1. In majority of the cases, the choice of the poison selected was determined by easy availability.
2. The incidence was found to be more prevalent among young adults (20-40 years of age).
3. The most common type of poison used among the subjects under study was pharmaceutical
products.
Thus the study indicates that restricting the availability of poisonous substances may be helpful in
bringing down the incidence of poisoning in the society.
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Acknowledgement
I express my sincere gratitude to the Indian Council for Medical Research for the opportunity to
undertake this project work as a part of the Short Term Studentship programme (2012). Sincere
thanks are also due to Dr.Anish.S., Govt. Medical College Thiruvananthapuram, for the help
rendered at different stages of this work.