https://doi.org/10.22502/jlmc.v4i2.

98 Original Research Article

Pattern of Acute Poisoning Attending a

Tertiary Care Hospital of Western Nepal
Raju Prasad Shakya,a,c Suraj Adhikari,b,c Rohit Bajracharyab,c

—–—————————————————————————————————————————————
ABSTRACT:
Introduction: Poisoning with various substances is a major public health problem and a reason for significant morbidity
and mortality throughout the globe. It is one of the most common presentation in an emergency department. This
study was conducted to determine the sociodemographic, poisoning types, and mode of poisoning in cases attending
a tertiary hospital of Western Nepal. Methods: A retrospective observational study of two years was conducted from
July 2014 to June 2016. Demography details, name of poisonous substance, and reasons for poisoning were reviewed
and analyzed using descriptive statistics. Results: A total of 65 cases of poisoning were recorded. The occurrence was
more common in female (n=44, 67.7%) with a F:M ratio of 2.1:1. Poisoning was most common in the age group of
11-20 years (32.3%). Most of the cases were students (37%) followed by farmers (26%). The most commonly abused
poisoning substance were organophosphorous compounds, zinc phosphide, and kerosene in adults, adolescents, and
children respectively. Oral route was the most common (99%) route of administration. Suicidal attempt, as a mode of
poisoning, accounted for 70.8% of total poisoning cases. Conclusion: Female and young people are at greater risk of
acute poisoning. Insecticide was the most common agent. The occurrence of poisoning and its morbidity and mortality
can be reduced by development and implementation of effective prevention strategies like restricting easy access to
poisons, establishing drug and poison information centers, and community awareness programs.

Keywords: organophosphate poisoning • poisoning • suicide

———————————————————————————————————————————————

INTRODUCTION:
Poison may be defined as a substance which three million per year and the number of deaths and
harms heath or destroy life when introduced in to the casualties are 3,00,000 per year worldwide.3
system or applied externally.1 Poisons are subtle and In Nepal, narcotic drug control Act 2038 and
silent weapons, which can be easily used without pesticide Act 2048 prohibits the misuse of narcotics
violence and often without arousing suspicion.2 The and pesticides. However, improper implementation
global incidence of poisoning is not known. Recently of these has lead to such problems.4 Poisoning is a
some review articles reported that the number of medical emergency and a patient is always invariably
intoxications with organophosphate pesticides was rushed to the hospital at the earliest possible moment
irrespective of the amount and nature of poison
ingested. All the cases of poisoning are admitted
_____________________________________________
through emergency service where the safety of life
a - Consultant Family Physician
b - Medical Officer
of the patient is the main issue for the doctor.5 The
c - Department of Emergency present study was conducted with the objective to
Lumbini Medical College Teaching Hospital, Palpa, Nepal investigate the pattern of acute poisoning cases in a
teaching hospital in Western Nepal.
Corresponding Author:
Dr. Raju Prasad Shakya
e-mail: rajushakyaa@gmail.com METHODS:
How to cite this article: This hospital based retrospective,
Shakya RP, Adhikari S, Bajracharya R. Pattern of acute poisoning observational study was carried out in the emergency
attending a tertiary care hospital of western Nepal. Journal of Lumbini department of Lumbini Medical College Teaching
Hospital, Palpa, Nepal during the period of two years
Medical College. 2016;4(2):90-3. doi: 10.22502/jlmc.v4i2.98.
___________________________________________________________________________________

J. Lumbini. Med. Coll. Vol 4, No 2, July-Dec 2016 90 jlmc.edu.np

 Shakya RP. et al. Pattern of acute poisoning attending a tertiary care hospital of western Nepal.

from July 2014 to June 2016. Ethical clearance was Table 1: Occupation of the patients
approved from the institutional review committee Occupation n %
of the institute. Medical records of all the poisoning Students 24 36.92
cases during that period were studied and the findings Farmer 17 26.15
were noted. Data regarding age, sex, occupation, Housewife 14 21.53
history of psychiatric illness, reasons for exposure, Service holder 4 6.15
and routes of exposure to the poison were obtained.
Laborer 2 3.07
Patients with food poisoning, snake or insect
Business-service 1 1.53
bite, and those brought by police for the investigation
Other 4 4.61
of alcohol consumption were excluded. Data were
entered into Microsoft Excel 2007 and analyzed with Total 65 100
SPSS-21 software. Descriptive data were presented
as frequency and percentage. Table 2: Reasons for intentional poison consumption
Reasons n %
RESULTS:
Domestic quarrel 30 65.2
A total of 65 cases of poisoning attended the Love /tragedy 6 13
emergency department during the study period of two To threaten Family 5 10.9
years. The mean age of female was 28 yr (SD=16.5) Financial 5 10.9
and male was 25.5 yr (SD=13.8) with overall F:M Total 46 100
ratio of 2.01:1. Most cases (n=21, 32.3%) were in the
age group of 11-20 year, followed by 16 (24.61%)
in 21-30 year. Ten (15.38%) cases belonged to age- Table 3: Types of poison used
group 21-30 year followed by six (9.23%) cases in Poisons n %
each of 1-10 year and 41-50 years. Thus the instances Organophosphates 21 32.31
of poisoning decreased with increasing age beyond Zinc Phosphide 17 26.16
ten years of age. Dhatura (Belladona) 11 16.93
Poisoning was most common among Alcohol 6 9.23
students. Occupation-wise distribution of frequency Paracetamol 4 6.16
of poisoning is shown in Table 1. Forty-six (70.76%)
Phenol 2 3.08
cases were of intentional poisoning whereas the rest
Antidepressant 1 1.54
19 (29.23%) were accidental. Among the intentional
Mushroom 1 1.54
cases, domestic quarrel was the most common cause
for poison consumption. Other causes of intentional Kerosene 1 1.54
poisoning is given in Table 2. Organophosphorus Acid 1 1.54
poisoning was the most common poison used. Total 65 100
Other poison were as shown in Table 3. Most of
the patients (n=40,61.5%) obtained poison that diagnosis, treatment and prevention are crucial in
was stored in home and the rest bought it from the reducing the burden of poisoning-related injury in
market. All most all (99%) poison were consumed any country.
orally. Less then half (n=30, 46.2%) of the cases had The present study revealed that the poisoning
formal education whereas 19 (29.2%) were literate was more common in female compared to male
without formal education and the rest 16 (24.6%) (2.01:1). Similar finding was obtained in the study
were illiterate. done in Bir hospital of Nepal with F:M ratio of
1.3:1 which is comparatively lower than ours and
DISCUSSION: in another study in Oman.6,7 Another study done in
Arrival of 65 cases of poisoning in the Kathmandu Medical College revealed a lower than
Emergency department of Lumbini Medical previous two studies F:M ratio of 1.09:1.8 Another
College over a period of two years emphasize the study showed the ratio of 2:1 which was comprable
seriousness of the problem of poisoning in this area. to ours.9 A study done in university hospital
Acute poisoning is an important clinical emergency emergency department in Turkey revealed F:M ratio
and contributor to morbidity and morbidity. Early of 3.5:1 which was much higher than ours.10 Female

J. Lumbini. Med. Coll. Vol 4, No 2, July-Dec 2016 91 jlmc.edu.np

 Shakya RP. et al. Pattern of acute poisoning attending a tertiary care hospital of western Nepal.

preponderance in this study could be accounted to group of people are victims of reactive depression
the fact that females are often exposed to the stress and subjected to stress in academic, financial, and
and strain of day to day life in our society. social sectors.11
By age group, 32.3% of the patients were Quarrel in the family was the most common
in 11-20 years and next 24.6% in 21-30 years, cause (70.76%) of intentional poisoning. Thus,
implicating that patients between 11 to 30 years misunderstanding at the family level has been the
constitute the majority of the patients. This is the prime factor responsible for intentional poisoning.
age of transition from childhood to adulthood, Organophosphorus compound was the most
from immaturity to maturity; so, they are prone common poison used and was found to be used in
to psychological, cognitive, social, cultural, and about a third (32.3%) of the cases. Commonly used
emotional stress. They are less mature to cope these organophosphates were methyl parathion (Metacid)
problems of life and may easily get carried away and dichlorovos (Nuvan).12 This is consistent with
making suicide their last resort. other studies carried out in Nepal.13-19 In a small study
In our study, 36.92% of the patients were from eastern part of the country, 62% of poisoning
students, 26.16% were farmer, and 21.53% were patients consumed Metacid as poison. However, a
housewife. Students were the most common group study done in Turkey revealed that the most common
to consume poison followed by the housewives in substance used for self-poisoning were medicinal
a study in the capital city of our country.8 Poisoning druges, antidepressants being the most common of
was more prevalent among farmers in our study. This them.10 This may be due to easy and wide-spread
may be due to the fact that our centre is located in the availability of organophosphates as insecticides in
rural hilly area of the country where the proportion the rural part of our agricultural country. It was also
of farmers are high. These groups are vulnerable for found that accidental poisoning commonly resulted
poisoning as they are under continuous financial and from intake of foods, especially mushrooms and
other stress during the life. dhatura (beladona). However, organophosphates
Regarding education, 29.23% of the cases are gradually replaced with phosphides and similar
were literate without formal education, 24.61% rodenticides due to their fast and more effective
of the cases were illiterate and rests of them had actions.20
formal education. Uneducated people comprised Among all the cases, 61.53% of the cases had
majority (53.84%) of the poisoning cases. This can poison stored in home. Agricultural insecticides are
be explained by the fact that failure in life is more generally stored in every home as agriculture is one
likely in uneducated people and they lack capacity of the most common occupation of the people in our
to tolerate the problems due to the lack of education. locality.
Majority of the cases (70.67%) consumed
poison intentionally and rest accidentally. A study CONCLUSION:
done in Bir Hospital in the capital city revealed We conclude that the poisoning is a common
that ninety-seven cases (98.0%) were intentional cause of hospital admission and a matter of concern
poisoning for suicidal attempt which is much higher in our place. Majority of them were intentional to
compared to our study.6 Unintentional poisoning harm oneself. Agricultural pesticides, which is
commonly resulted from intake of foods, especially common in our place, constitute the most common
mushroom, or was mistakenly taken as food or poison substance. Hence the pesticides must be
water under influence of alcohol. This may be due sold in the presence of a witness who should be
to fact that the life in capital city is difficult for those known to the clients. Family quarrel was the most
who are already facing problems in life. Indifferent common cause of poisoning and it can not be treated
attitude of its inhabitants, cost of living, and lack of medically. Here comes the need for psychological
time for themselves and their family can be some evaluation and counseling which may minimize the
contributing factors. Again, intentional poisoning risk of next attempt of self harm.
may be more common these days because a large

REFERENCES:
1. Bhoopendra S, Unnikrishnan B. A profile of acute 2. Pothireddy S, Mohanty MK. Study of poisoning cases in a
poisoning at mangalore (south India). J Clin Forensic Med. tertiary care Hospital. JSIMLA. 2011;3:14-8.
2006;13:112-6.

J. Lumbini. Med. Coll. Vol 4, No 2, July-Dec 2016 92 jlmc.edu.np

 Shakya RP. et al. Pattern of acute poisoning attending a tertiary care hospital of western Nepal.

3. Harvey RA, Champe D. Lippincott's illustrated Reviews: 11. Z. Ramesha KN, Rao KB, Kumar GS. Pattern and outcome
Pharmacology, 4th ed. USA: Lippincott Williams and of acute poisoning cases in a tertiary care hospital in
Wilkins; 2009. 535 p. Karnataka, India. Indian J Crit Care Med. 2009;13:152-5.
4. Pokhrel D, Pant S, Pradhan A, Mansoor S. A comparative 12. Lohani SP. An epidemiological study of poisoning cases
study of poisoning cases in central, zonal and district Reported to the Nepal Drug and poison information
hospitals . KUJSET. 2008;5:40-8. center, Kathmandu, Nepal Drug and Poison Center.
5. Dash SK, Raju AS, Mohanty MK, Patnaika KK, Siddharatha 13. Kafle KK, Nepal MK, Sharma SR, Pokharel RP. Poisoning
P, Mohanty S. Socioeconomic Profiles of Poisoning Cases. cases at TU Teaching Hospital. J Inst Med. 1989;11:297-
JIAFM. 2005;27:133-8. 301.
6. Singh DP, Acharya RP. Patterns of poisoning in Nepal. J 14. Suvedi BK. A retrospective study of poisoning cases at Bir
Inst Med. 2006;28:3-6. Hospital, Nepal. J Inst Med. 1990;12:296-302.
7. Lal SB, AL-Wahaibi SS, Al-Riyam MM, Al-Kharusi K. 15. Kafle KK, Gyawali KK. Organ phosphorous commonest
Profile of acute poisoning cases presenting to health poisoning agent. J Inst Med. 1992;14:228-33.
centres and hospitals in Oman Eastern. Mediterranean 16. Poudyal BP. Poisoning: Pattern and Profile of Admitted
Health Journal. 2003;9:944-54. Cases in a Hospital in Central Nepal. J Nep Med Assoc.
8. Khadka SB, Ale SB. A study of poisoning cases in emergency 2005;44:92-6.
Kathmandu Medical College Teaching Hospital. KUMJ. 17. Ghimire RH, Sharma SP, Pandey KR. A Comparative study
2005;3:388-91. of Acute Poisoning in Nepal at Tertiary and Secondary
9. Baydin A, Yardan T, Aygun D, Doganaya Z, Nargis C, Level Hospitals. J Nep Med Assoc. 2004;43:130-3.
Incelatin O. Retrospective evaluation of emergency service 18. Gupta SK, Joshi MP. Pesticide Poisoning Cases Attending
patients with poisoning: A 3-year study. Advances in Five Major Hospitals of Nepal J Nep Med Assoc.
therapy. 2005;22:650 -8. 2002;41:447-56.
10. Gulohglu C, Kara IH. Acute poisoning cases admitted to a 19. Prasad PN, Karki P. Poisoning cases at TUTH emergency:
university hospital emergency department in Diyarbakir. a one - year review. J Inst Med. 1997;19:18-24.
Turkey. Human and experimental toxicology. 2005;24:49-
54. 20. Karki RK, Risal A. Study of Poisoning Cases in a Tertiary
Care Hospital. Kathmandu Univ Med J. 2012;10(4):70-3.

J. Lumbini. Med. Coll. Vol 4, No 2, July-Dec 2016 93 jlmc.edu.np