Assessment and Evaluation of Poisoning Cases

: A substance is considered poisonous if it causes harm damage or death when ingested, inhaled or comes in contact of the body. Poisoning is a significant global health issue and therefore it is crucial to understand the type, cause, severity and, treatment pattern in order to take the appropriate measures because there is a massive epidemic of non-communicable diseases that can affect people of all ages. The main objective of the study was to assess and evaluate the poisoning cases. It was a retrospective and prospective study carried out for a period of 6 months from April 2023 to October 2023. The study involved 233 patients. Male preponderance (72.53%) was seen over the female (27.46%). The people between the age group of 21 to 30 years (33.47%) were more prone to poisoning cases. Most of the patients were married (62.66%). About 84.87% of people consumed poison deliberately due to various causes like financial crisis, family conflict, relationship failure, under the influence of alcohol, depression, and, other medical issues. 66.52% of people were from the rural background whereas 33.48% were from the urban background. Farmers (27.89%) were the major group of the population affected by the poisoning cases followed by the homemakers (17.16%).


I. Introduction
A Substance is considered poisonous if it causes harm or damage or death when it is ingested, inhaled or comes in the contact of the body.Acute exposure to toxic substances lasting less than twentyfour hours is considered as poisoning (1).Poisoning is a significant global health issue.It is crucial to understand the type and severity of poisoning in order to take the appropriate preventive measures because there is a massive epidemic of non-communicable disease that can affect people all ages and socioeconomic status.• Email: editor@ijfmr.com

Procedure methodology
After obtaining the approval from the institutional ethical committee, a well-designed data collection form was prepared to collect the data.This data collection from included the demographics of the patients like name, age, gender, occupation, address, economic status, and qualification, poison information, patient past medical history, laboratory abnormalities, specific antidote if administered, treatment chart, and discharge summary.The collected data was documented in the excel sheets for the easy retrieval, storage and analysis.

III. Result Details of Gender Distribution:
Among the 233 poisoned patients 64 (27.46%) females and 169 (72.53%) males.(Table 1 and Figure1  The patients were grouped into different categories based on their age.Among them 22 (9.44%) patients were in the age group between 1 Month to 10 years, 19 (8.15%) patients were in the age group between 11 to 20 years, 78 (33.47%) patients were in the age group between child 21 to 30 years, 61 (26.18%) patients were in the age group between 31 to 40 years, 29 (12.44%)patients were in the age group between 41 to 50 years, 13 (5.57%)patients were in the age group between 51 to 60 years, 8 (3.43%) patients were in the age group between 51-60 years, 1 (0.42%) patient was in the age group between 71 to 80 years and 2 (0.85%) patients were in the age group between 81 to 90 years.(Table 2 & Figure 2).

IV. Discussion
During the study period 233 poisoned cases were assessed and evaluated.In this study, among 233 patients, 169 (72.53%) were male whereas remaining 64 (27.46%) were female.This finding was similar to a prospective observational study carried out in Adhichunchanagiri College of Pharmacy, which reported male preponderance (63.0%) than females (37.0%) (15).Male population are more prone to poisoning may be because of the factors like work pressure, stress, financial issues, family conflicts or agricultural loss or loss in business.Relationship failure is also a reason for the male young adults for intentional poisoning.
Young adults and middle-aged people are more prone to poisoning may be because of the work stress, socioeconomic status, financial crisis or mental condition.
The marital status of the patients showed that 146 (66.66%) were married whereas 87 (37.34%) were single.This may be because financial issues, family conflicts, failure to understand each other, being less supportive to each other or exposure or exposure to more stressful situation.The severity the poisoning cases were categorized based on the signs and symptoms, complaints on admission, neck holding, GCS scale and was classified as mild, moderate, severe.177 (75.96%) cases were mild, 26 (11.15%) cases were moderate and 30 (12.87%) cases were severe.Most of the cases were mild may be because of the factors like early admission to the hospital, small amount of consumption, early diagnosis and management or use of proper general management techniques.The incidence of poisoning cases was more frequent in rural population 155 (66.52%) and 78 (33.47%) in urban population.Among the rural population 126 (81.29%) were male and 21 (18.70%) were female and among the urban population 42 (53.84%)were male and 36 (46.15%) were female.This may be because of poor literacy rate, poor socioeconomic status, agricultural loss or financial crisis.Intentional poisoning was the most common (84.97%) manner of poisoning in this study when compared to accidental poisoning (15.02%).The reasons for the intentional poisoning were depression (5.55%), personal issues (16.16%),Fight and family conflict (18.18%),Relationship failure (8.08%), financial crisis (14.64%), overdose (1.51%), Medical issues (5.05%), under the influence of alcohol (18.68%) and unknown (12.12%).This result is similar to a study conducted at Northeast Ethiopia which was a retrospective cross-sectional study with 64.2% of intentional poisoning (5).Accidental poisoning was the most common in the younger population between the age of 0 to 10 years.In this study the most common occupation was found to be farmer (27.89%), followed by homemakers (17.16%), students (9.01%), casual labourers (4.72%), driver (3.43%), others (10.30%) which includes occupation like businessman, mechanic, teacher, ward boy, gardener, unemployed, bar attenders etc. and unknown (27.46%).The most common occupation was found to be farmers may be due to the reasons like financial crisis natural calamities and agricultural loss.Homemakers were the next common occupation may be because of loneliness, emotional stress, family pressure and family conflicts.This study showed that most the victims consumed poison in the morning (27.04%)followed by evening (22.31%), night (21.86%) and afternoon (19.31%).
After admission the patients were evaluated for the laboratory abnormalities.It was found that 137(58.79%)patients had hematological abnormalities followed by liver function abnormalities (46.78%), lung function abnormalities (9.44%), metabolic abnormalities (16.31%), cardiac abnormalities (5.15%), renal function abnormalities (9.02%), microbiological abnormalities (6.86%), and electrolyte imbalance (9.45%).The hematological abnormalities are seen because the poisons may interfere with the oxygen carrying capacity of red blood cells, reduces the half-life of RBCs.In most of the cases there was an elevated leukocyte and neutrophil count whereas decreased lymphocyte count.Since most of the toxin are metabolized in the liver, it tries to detoxify the toxins, which in turn causes abnormalities in liver functions altering the liver enzyme activities.
During the hospital stay the most common drug administered was antiemetics (90.99%) followed by proton pump inhibitors (90.12%) and multivitamins (70.25%).Antiemetics were most commonly used because nausea and vomiting were the most common complaint.The other medications that were used are atropine, antidepressant, nutritional supplements, antipyretics, analgesics, antibiotics, potassium supplements, anticoagulants, N Acetyl cysteine, corticosteroids, sedatives, H2 receptor antagonist, calcium supplements, hypoglycemic agents, expectorants, pralidoxime and anti-snake venom.As most of the poison do not have any specific antidotes, the patients were treated symptomatically.On admission the most common complaint was vomiting (65.24%) followed by nausea and burning sensation (12.88%).The other signs and symptoms at the time of admission were epigastric pain, abdominal pain, breathing difficulty, drowsiness, generalized weakness, cough, throat pain, fever, chills, involuntary urination, salivation, involuntary motion, seizures, inability to move, loose stools, blurred vision, tongue fasciculation, chest pain, headache, sweating, tachycardia, altered sensorium, pinpoint pupil and frothing.
Poisoned patients are to be evaluated and stabilized so as to prevent and treat life threatening signs and symptoms.Therefore, the patients were generally managed.The most common management method used was fluid therapy (88.42%) followed by gastric lavage (78.12%), electrolyte balance (67.82%), nebulization (20.60%) and mechanical ventilation (12.01%).On admission 85.40% of patients were conscious during the time of admission and 14.60% of patients were conscious.All the 233 patients received symptomatic patients whereas 55.80% of them received specific therapy, that is the patients were treated with antidotes along with the symptomatic therapy.
The most common type of poisoning was found to be organophosphorus compounds (34.76%) followed by medicinal agents (15.02%).Organophosphorus was the most common type as it is easily available in the market or household without any law or regulations.Most of the medicinal agents that were used for the intentional poisoning were the over-the-counter drugs.
The different types of poisoning were categorized under the different classes of poisons.Among the various classes, insecticides (50.64%) were the most common followed by medications (9.01%).
All the 233 patients consumed poison through oral route, whereas one patient administered poison through both oral and topical route by spraying the poison on the wounds.The longest stay in the hospital was found to be 21 days.Around 85.84 % patients were in the hospital in between 1 to 5 days followed by 7.73% of patients stayed between to 10 days.During the hospital stay, the patients were treated symptomatically, specifically and were discharged in a healthy condition.About 77.68% of the poisoned patients were fully recovered at the time of discharge whereas 15.87% of patients were discharged against medical advice due to the reasons like financial crisis or relatives or family members not willing to continue the therapy.6.00 % patients died may be because of the delayed admission to the hospital after the consumption, Multiple organ dysfunction, treatment failure, consumption of unknown compounds or lack of or insufficient primary care.Most of the poisoning cases were deliberate self-harm and hence it is very important that the patient receives psychiatrist care so as to prevent reoccurrences and further complications.All the intentional poisoning cases were referred to the psychiatrist care where 65.66% of the patients took the psychiatrist care.

V. Conclusion
In this study the most common type of poisoning is organophosphorus poisoning followed by the pharmaceutical agents.Most of the poisoning cases were deliberate self-harm due to various reasons like family conflicts, relationship failure, personal issues, financial crisis, medical issues and under the influence of alcohol.
• Most of the poisoning cases were due to the consumption of insecticides or pesticides therefore the government has to bring a strict rules and regulation for the marketing of agricultural products.• Awareness program has to be conducted among the people regarding the hazardous effects of the poisons.
• Financial burden was one of the causes for deliberate self-harm and hence government has to up bring certain schemes like increasing the procurement of grains and crops from the farmer, providing loan to the farmers in less interest rate, supporting small scale business, fixing up the minimum price for all the crops and grains, promoting the use of organic products, establishment of regulated market and cooperative market.• Financial awareness has to be created among the people and restrict activities like dowry, gambling etc. • Work pressure and stress should be managed by time management and priority management.
• People should be educated to manage the social and family fear.
• The labels of the harmful chemicals and agricultural products should contain a 'warning' or 'caution' sign with pictures of the effect and complication of consumption.• Use of organic or natural agricultural products should be promoted.
• Maintaining a healthy family relation, fighting over small things, suspecting or not trusting each other should be avoided.• A well-maintained social health is one of the important parameters that helps people from mental health condition like depression, anxiety, and suicidal thoughts.• If any person is suffering from any of the mental illness like depression, anxiety etc. provide the required psychiatric care as soon as possible.• Provide psychiatric support to the person who has already tried self-harm and also the patient who threatens to commit self-harm.• Alcohol and suicidal thoughts are corelated to each other.Especially in India people tend to drink alcohol in grief.Alcohol increases tendency of suicidal thoughts hence intake of alcohol should be restricted especially in the painful situation.• As the pre-teens and teenagers, grow it becomes difficult for the parents to understand the children.
Therefore, it is important that the parents cope up with the children in the difficult situations.
• If the parents suspect any type of changes in the child's mental behavior, try to talk to them or seek the psychiatric counselling.• All the pharmaceutical products should be dispensed only based on the prescription and refill information.• Unwanted or the expired drugs should be discarded and kept away from the children and people with abnormal mental health.• Mental health awareness programme should be conducted frequently especially in the rural areas.
• Accidental poisoning was the most common in the children and hence educating the parents regarding the disposal of the waste medications, unused liquids and syrups.• Educating the parents to keep all the hazardous substances away from the reach of the children, not to address anything harmful as a sweet or edible substances, keep all the attractive and colorful chemicals away from the children.• Educating people regarding the diversional therapies like listening to music, singing, yoga, aromatherapy and meditation whenever feeling low can help people to prevent suicidal thoughts.• Covering oneself with protective clothing, masks and gloves while using the agricultural products or any hazardous chemicals can prevent the accidental exposure.Washing hands and body with the nongermicidal soap after the use and redressing with the fresh clothes.• Wearing shoes or boots while walking in the areas rich in long and thick grass.
• Carry a torch or flashlight while walking outdoors at night.• Snakes usually prefer the warm places to stay and hence be careful while removing or moving the firewood, logs, slippers and shoes from the slipper stand or the corners of the house.• Use repellents for the rodents and snakes in the storerooms and basement.
• Do not handle a snake even if it is dead because some snake pretends to be dead to avoid the attack.

Figure 3 :
Figure 3: Details of Marital status

Figure 19 :
Figure 19: Details of result of the therapy (n=233)

Table 1 : Details of Gender Distribution (n=233) Gender No. of Patients % of patients
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