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Treatment Approaches for Management of Poisonings in India

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Treatment Approaches for Management of Poisonings in India Central Annals of Public Health and Research Research Article *Corresponding author Asawari Raut, Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth Deemed Treatment Approaches for University, Pune-411043, India, Tel: 8805058493; Email: Submitted: 17 July 2017 Management of Poisonings in Accepted: 28 August 2017 Published: 30 August 2017 India Copyright © 2017 Raut et al. Asawari Raut1*, Atmaram Pawar1, Kavya Shaj1, and Priti Dave2 1Department of Clinical Pharmacy, Bharati Vidyapeeth Deemed University, India OPEN ACCESS 2Department of Medicine, Bharati Vidyapeeth Deemed University, India Keywords • Intentional poisoning; Awareness; Poisoning management; Inhalational poisoning Abstract Background: Poisoning is a common medical emergency needing prompt medical interventions. The study focuses on pattern of toxic agents, drug utilization, management and outcome in poisonings reported. Methods: The cross sectional study was carried out on patients admitted to two urban hospitals in Pune, Maharashtra from January 2014 - March 2016. Results: Total 1078 cases of poisoning were reported with male (57.1%) predominance. The cases reported ranged from 8 months to 72 years old in age with a mean (± SD) 37.8 ± 27.3. Intentional poisoning was more common (53%). Route of exposure was mostly Ingestion (72.5%) followed by Bite/ Sting (26.4%), Inhalational (0.8%), Injection (0.1%) and Eye (0.1%). Household and agricultural agents (56.4%) were associated with most poisoning followed by Animal Bites and Stings (26.4%). The mortality reported was 9.7%. The management included Supportive treatment, Antidotes, and Enhanced Elimination Techniques. Supportive treatment was mainly with Gastro protective (94.3%) and Anti-Microbial (77.9%) agents. The antidote was used in 70.9% cases and mostly included Anti-Snake Venom (24.4%) followed by Atropine (21%) and Pralidoxime (18.1%). Enhanced Elimination Techniques included Gastric Lavage (76.3%), Nasogastric Aspiration (7.2%), Hemodialysis (0.1%), Activated Charcoal (4.5%) and Eye wash (0.1%). Conclusion: The treatment approaches were based on parameters such as route of exposure, Toxic agent involved and age of the patient. The pharmacist can play a vital role in the recommendation of the rational management plan in Poisonings. INTRODUCTION Due to the paucity of information regarding poisoning cases in India, the introduction of new guidelines and updating current An estimated 193460 deaths occurred worldwide due to protocols needs knowledge of demographics and management poisoning as published by WHO of which a major proportion was of poisoning cases. To understand the interventions needed in from low and middle-income countries [1]. 110688 deaths due to poisoning were reported in India in 2012 according to a national professionals studies are needed to be conducted [8]. the management of poisoning and define the role of health care report [2]. The study was conducted in Pune district in the state of The outcome of poisonings is depended on the speed with Maharashtra in India. According to the most recent census in th which the patient is brought to medical care, understanding of 2011, the total population was 9.4 million making it the 4 most the poison’s toxicity degree and the readiness of medical care populous district in India [9]. Pune has many industrial areas which provide easy accessibility of a large number of chemicals [3]. The high mortality rate associated with poisoning is often and pesticides resulting in the tremendous use of these agents related to a delay in diagnosis and/or improper management for poisoning and the agricultural diversity has resulted in an [4]. Globally, the management of the critically poisoned patient increase of animal bites and stings and also accidental exposures centers on careful supportive care and further maximized to insecticides and pesticides. So far, this is the only study with appropriate decontamination, antidote administration, conducted in this area focusing on poisonings. elimination enhancement and pharmaceutical interventions [5]. It hugely depends upon institutional protocols, healthcare METHODOLOGY facilities, and drugs. It is necessary for each medical setting to Study area regularly evaluate and review drug utilization to rationalize drug The study was conducted in Pune district of Maharashtra, use and enhance patients’ outcome [6]. Annual epidemiologic which resides a total population of 9.4 million inhabitants with data on poisonings treated at each medical setting will also help a male to female ratio of 1.1:1. It forms a part of the tropical to better handle and manage drug, antidote and other technical requirements [7]. variation in temperature and rainfall. monsoon land and therefore shows a significant seasonal Cite this article: Raut A, Pawar A, Shaj K, Dave P (2017) Treatment Approaches for Management of Poisonings in India. Ann Public Health Res 4(4): 1068. Raut et al. (2017) Email: Central The Pune city resides many multi specialty hospitals. The Table 1: Characteristics of Poisoning cases observed. Government hospital, a 380 bedded multi specialty hospital, Characteristics Number of cases is located in Pimpri – Chinchwad which engulfs a wide area of Demographic surrounding suburban and industrial areas like Aundh, Bhosri, Male 616 Nigdi and villages like Moshi, Chikli, Dehu, etc. The private Female 462 teaching hospital is a 900 bedded hospital with hi-tech super Age (Mean ± SD) 37.8 ± 27.3 specialties. It is located in inner suburbs of Pune which includes Route areas like Katraj, Ambegaon, Vadgaon, Parvati Hill, etc. These Ingestion 782 are the industrial and agricultural areas where a high number of Injection 1 chemical or pesticide poisoning can be observed. Inhalational 9 Population and sampling Bite/Sting 285 Eye 1 The study was cross-sectional and made use of retrospective Reason and prospective extraction of data from records available at the Intentional 571 government and private teaching hospitals respectively. All cases Accidental 475 of poisoning available in the medical record departments were Unknown 32 included in the study. Length of Hospital Stay (Mean ± SD) 2.5 ± 1.6 Data collection and extraction Outcome Symptoms improved 836 The records were collected from Medical Record Department of the respective hospitals. The data collection period was from DAMA 137 January 2014 to March 2016. The cases were reviewed for gender, Death 105 age, route, and reason of poisoning and agents, management, and Agents drug utilization. Household and Agricultural 608 Animal Bites and Stings 285 RESULT Drugs 116 Miscellaneous 39 Demography of poisoning cases Unknown 30 During the study period of 28 months, 1078 cases of poisoning were reported to the emergency department of the hospitals, out used as an adjunct for eliminating toxins and diazepam for of which 616 (57.1%) were male and 463 (42.9%) were Female. alcohol withdrawal symptoms. Oxygen Inhalation was given The cases reported ranged from 8 months to 72 years old in age to patients with Inhalational poisoning with insecticides and with a mean (± SD) 37.8 ± 27.3. This suggestive that on an average petroleum. Antidotes were used in 70.9% cases and included 38 cases was reported per month which demands attention to Anti-Snake Venom (24.4%), Atropine (21%), Pralidoxime the situation. The reason for poisoning was primarily Intentional (18.1%), Rabipur (3%), N-Acetylcysteine (1.4%), Neostigmine (53%) than Accidental (44.1%) and Unknown (3%) and Route of (3.2%). Other Enhanced Elimination Techniques were also used. exposure was mostly Ingestion (72.5%) followed by Bite/Sting These Included Gastric Lavage (76.3%), Nasogastric Aspiration (26.4%), Inhalational (0.8%), Injection (0.1%) and Eye (0.1%). (7.2%), Hemodialysis (0.1%), Activated Charcoal (4.5%) and Eye The agents responsible were categorized as Household and wash (0.1%) [Table 2]. Agricultural Agents (56.4%), Animal Bites and Stings (26.4%), Drugs (10.8%), Miscellaneous (3.6 %) and Unknown (2.8%). Management in different patient population Few Intentional poisonings were a mix of above agents and some The usage pattern of Antidote and the Enhanced Elimination with alcohol as well. Length of Hospital Stay ranged from 1-15 Techniques were observed in different patient population; days with a mean (± SD) 2.5 ± 1.2. Mortality reported was 9.7% Pediatric, Adult, and Geriatric for different toxic agents. In 276 and Symptoms Improved in most (77.6%) cases but 12.7% were cases of Pediatrics aged 0-18 years, Antidotes were given in 135 DAMA (Discharged against Medical Advice) or Absconded [Table (48.9%), Gastric Lavage in 156 (56.5%), Nasogastric Aspiration 1]. in 12 (4.3%), Activated Charcoal in 24 (8.7%) and Eye Wash in 1 Treatment approaches in poisonings (0.4%). In 760 cases of Adults aged 19-55 years, Antidotes were given in 600 (78.9%), Gastric Lavage in 648 (85.3%), Nasogastric The Management of admitted poisoning cases was done Aspiration in 66 (8.7%), Hemodialysis in 1 (0.1%), Activated by Symptomatic treatment, Antidote, and Other Enhanced Charcoal in 24 (3.2%). Finally, in 42 cases of Geriatric above age Elimination Techniques. Symptomatic Treatment were done 55 years, Antidotes were given in 30 (71.4%) and Gastric Lavage with following drugs: Anti-Microbial (77.9%), Gastro protective in 18 (42.9%) [Table 3, Figure 2]. (94.3%), Anti-allergic (52.7), Anti- - Hypertensive (54%), Antipsychotics (44.1%), Supplements Treatment approach according to toxic agents Inflammatory (39.3), Anti (5.6%), Anticonvulsants
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