Clinical profile and outcome of children presenting with poisoning or intoxication: a hospital-based study (original) (raw)
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When the effect of poisoning start appearing within 24 hours of exposure of the poison it is termed "acute poisoning". Exposures may be through oral, transdermal, inhalation, or intravenous route. Our aim is to determine the clinical course and outcome of acute poisoning. and to determine the socio-demographic characteristics of the study population. Our study is a hospital-based prospective observational study conducted in Postgraduate Department of Pediatrics, G.B Pant children's Hospital an associated hospital of Government Medical College Srinagar Jammu and Kashmir India. This study was conducted over two (2) years with effect from November 2019 to November 2021. The study participants were children in the age group of 6 months-18 years old. In our study, 572 cases with acute poisoning were studied over two years; the mean age of childhood poisoning was 3.8 years. The majority of the poisoning cases were accidental, more common in a male child with a male to female ratio of 1.6:1. Most of the cases were seen in lower-middle-class families (65.7%). Organophosphorus was the most common agent involved. Oral ingestion was the predominant route of poisoning. The mean duration of hospital stay was 4.5 days. 35% of cases were treated with a specific antidote. All patients survived. Most of the accidental poisoning seen in less than five years age group due to their innovative character, curiosity, mouthing tendencies, and exploratory nature. The majority of accidental poisonings are preventable using simple preventive measures and reducing the significant mortality among children. Despite rapid socioeconomic changes, organophosphorus remains the commonest agent in pediatric poisoning.
Backround:Poisoning is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than 5 years is accidental. Objective of study was to study the incidence, clinical profile and outcome of childhood poisoning. Methods: This was a retrospective study done in patients, who were admitted in pediatric wards, pediatric intensive care unit of GB Pant Children Hospital with history of Ingestion of poison from May 2011 to May 2015. Results: There were total 1272 children enrolled in study. Male: Female Ratio was 1.52:1. Mean Age of presentation was 3.18 years. Among 1272 patients, 57.23 patients received pre-referral treatment in the form of gastric lavage, atropine etc. OrganoPhosphorous was the commonest poisoning seen in 332 patients (26%) followed by kerosene (hydrocarbon) poisoning 240 patients (18.83%), Drugs 232 patients (18.23%). During treatment 30.2% received Antidotes, 55.7% received antibiotics, Gastric lavage and anticonvulsants in 47.7% and 2.5% respectively. Overall survival was 95.2%. The time interval between Intoxication and presentation to hospital, mean Glasgow comma scale (GCS) and presence of Coma (GCS<8) were significantly different between survivors and expired cases. Conclusion: Organophosphorus is the commonest agent involved in childhood poisoning. Overall outcome is good 95.2% Survival in our hospital. The time gap between the poisoning, presentation to hospital and presence of coma predict mortality.There is a definitive statistical significance of mortality with development of Respiratory failure, seizures and development of coma as the mortality was higher in patients who developed the above clinical manifestations than those who did not developed the above features
Indian journal of child health, 2019
A cute poisoning, a common pediatric emergency, causes significant morbidity and mortality, especially in developing countries. According to the American Association of Poison Control Centre, nearly 50% of the poisoning occur in children <6 years of age and most of them are unintentional [1]. In India, accidental poisoning is the 12 th leading cause of admission in pediatric ward and accounts for about 1.0% of the hospitalized patients with incidence varying from 0.3% to 7.6% [2,3]. The nature of substance incriminated in poisoning is influenced by prevalent social, economic, and cultural practices. Many studies from developing and developed countries show that common household products, rather than drugs, are now implicated in the majority of pediatric poisonings [4,5]. Demography, socioeconomic status, education, local belief and customs, availability of poisonous substance, occupation prevalent in the society, religious, and cultural influences are the various factors that determine the cause and types of poisoning in different parts of the world [4]. Household substances such as kerosene, cleaning agents, and pesticides account for the majority of poisoning in India, whereas drugs are the common offending agents in western countries. With increasing urbanization and rapid socioeconomic development in India during the past decade, change in pediatric poisoning profile and outcome is to be expected, keeping this in mind, we have conducted this study. MATERIALS AND METHODS This prospective observational study was conducted in a tertiary care teaching hospital in New Delhi, India, from January 2016 to December 2016. The study was approved by the institutional ethical review board. A written informed consent was obtained from parent/legal guardian before enrollment. Children in the age group of 2 months-12 years, who were presented with acute poisoning to pediatric emergency, were enrolled for the study. Those with food poisoning, chronic poisoning, allergic reactions to drugs, animal bites, and stings were excluded from the study. Acute poisoning was defined as adverse effects occurring following oral or dermal administration of single or multiple doses of a substance given within 24 h or an inhalation exposure of 4 h. A total of 174 children with acute ABSTRACT Background: Childhood poisoning is a common but preventable problem worldwide with incidence varying from 0.3% to 7.6%. Demography, socioeconomic status, education, local belief and customs, occupation, religious, and cultural influences determine the cause of poisoning. Aim: This study was conducted to understand the recent changes increasing urbanization and rapid socioeconomic development in India during the past decade and to find out the change in pediatric due to poisoning profile. Materials and Methods: This study was conducted in a pediatric ward of a tertiary care hospital in North India during the period of January 2016-December 2016. A total of 174 children admitted with acute poisoning in the hospital during the study tenure were enrolled for the study. Clinical and demographic data were recorded in a predesigned proforma and results were compared with the previous studies from the region. Results: Mean age at presentation was 3.7 years, wherein males outnumbered females. Accidental mode (97%) was the most common mode of poisoning while ingestion (99%) was the most common route of exposure. The common agents incriminated in decreasing order of frequency were corrosives (24.71%), pyrethroids (12.64%), and kerosene (9.77%). Majority of patients belongs to lower middle class (57%) and urban areas (61%). Most children present with mild symptoms, of them vomiting was the most common (65%) and 12.6% developed complications. Mean duration of hospital stay was 2.5±1.91 days with a mortality of 2.16%. Conclusion: There is changing pattern in acute poisoning in children with decline in incidence of kerosene and pesticide poisoning while increase in corrosives and parathyroid poisoning. Low Glasgow Coma Scale and time lapse between poisoning and presentation to the hospital can be a predictor of high mortality.
Pattern of acute poisoning in children in a tertiary care hospital in eastern Nepal
International Journal of Contemporary Pediatrics, 2016
A poison is any substance that causes harm to a living being and almost any substance can act as a poison if a sufficiently large dose is absorbed. 1 It is still an important public health problem in children and represents a large number of admissions in emergency units. According to the WHO Global Burden of Disease project, an estimated 345 814 people of all ages died worldwide as a result of "accidental" poisoning in 2004. Although the most of these accidental poisonings were among adults, 13% occurred among children and young people under the age of 20 years. 2 A survey of 16 middle-income and high-income countries revealed that, unintentional injury death among children aged between 1 and 14 years, poisonings ranked fourth after road traffic crashes, fires and drowning. 3 Poisoning accounts 2% of all childhood deaths in the developed world and over 5% in the developing countries. 4 In India, the reported figures for fatal poisonings ranged between 0.6% and 11.6%. 5 A study done in Nepal shows that 1.79% of the total admissions and 6.38 % mortality of pediatric admissions were due to poisoning. 6 The pattern and types of poisons vary in different parts of the world depending on various factors such as demography, education, socioeconomic status, local ABSTRACT Background: Acute poisoning in children is a major preventable cause of morbidity and mortality. The purpose of this study is to analyze the current pattern of acute poisoning in children. Methods: This study was a retrospective hospital based analysis of data in children with acute poisoning admitted from January 2013 to December 2013. The demographic profile and outcome were recorded and analyzed. Results: A total number of 64 children (36 males & 28 females) were admitted with acute poisoning. It constituted 3.4% of the total admissions and 4.4% of the total deaths. The maximum number of children 25 (39.1%) was of the age group 1 to 5 years. Fifty-one (79.7%) were admitted in Ward and 13 (20.3%) in Pediatric Intensive Care Unit (PICU) among which 4 (6.25%) patients were put in mechanical ventilation. The most common poison involved was organophosphorus compounds 24 (37.5%) followed by mushroom 16 (25%) and kerosene 11 (17.2%). Mean time interval between ingestion and admission to hospital was 6.87 ±8.33 hours. The majority of the poisoning 28 (44%) occurred between 2pm to 7 pm. Forty-nine (76.6%) of the poisonings were non-intentional and 14 (21.6%) were intentional. Average duration of hospital stay was 4.14±1.94 days and vomiting was the commonest clinical manifestation. Of all the patients, 28 (43.8%) received pre-referral treatment, 44 (68.8%) antidotes and 22 (34.4%) gastric lavage. Conclusions: In our study, most of the poisoning was non-intentional and 1 to 5 years old children were at greater risk for poisoning. The main substance was organophosphorus.
Trends of Poisoning Among Children at Kasturba Hospital, Manipal
Journal of Health and Allied Sciences NU, 2013
Background: Pediatric poisoning is a common medical emergency and also associated with a high morbidity and mortality in children. In developing countries like India, poisoning emergencies are becoming a major cause of mortality in infants and toddlers. Among the various studies conducted on poisoning in our country, the study on poisoning is predominantly on adults and hence this study is taken up to understand the incidence of childhood poisoning cases. Method: A ten year retrospective study from January 1999 to December 2008 was conducted at the Department of Forensic Medicine & Toxicology, Kasturba Medical College, Manipal, to comprehend the magnitude of childhood poisoning cases at Kasturba Hospital, Manipal. Results: Insecticide poisoning was the most predominant poisoning followed by venomous bites. Conclusion: Our study examines the most common poison involved and route of intake among children to identify specific ages at risk and give suggestions so as to reduce the morbid...
Journal of Universal College of Medical Sciences, 2022
Poisoning in children is one of the leading public health problem in low and middle income countries and a common cause of morbidity and mortality. MATERIAL AND METHODS This prospective observational study was conducted for one year from 1 June, 2019 to 31 May 2020 to study the clinicoepidemiological pattern and outcome of children with poisoning in a tertiary care hospital of Western Nepal. RESULTS Total 38 children with poisoning were admitted and enrolled during the study period. The frequency of poisoning in children aged 0-5 years, 6-10 years and 11-16 years were 47.4%, 18.4% and 34.2% respectively. Poisoning was predominant in females (n=21, 55.3%). Majority poisoning cases (55.3%) were noticed in between May to August. More than three-fourth of the poisoning cases were noticed in the afternoons and evenings. Pesticides (organophosphorus, fungicide, herbicide, aluminium phosphide, and household rodenticides/insecticides) constituted 55.7% of total poisoning cases. Household rodenticides/ insecticides, volatile hydrocarbons and organophosphorus poisonings were noticed in 23.7%, 15.8% and 13.2% respectively. Three-fourth of the cases were symptomatic during the presentation where vomiting (76.3%), abdominal pain (34.2%) and constricted pupils (18.4%) were three major clinical symptoms and signs due to poisoning. About 84.2% cases survived. Complications were observed in about 15.8% cases where shock and respiratory failure was seen in 10.5% each followed by pneumonia (7.9%) and hepatitis (5.3%). CONCLUSION Poisoning was common in children less than 5 years of age and majority of them were accidental in nature. Household rodenticides/insecticides, volatile hydrocarbons and organophosphorus poisonings were common types of poisoning.
Poisoning in children: Indian scenario
Indian Journal of Pediatrics, 1998
The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23–3.3% of the total poisoning. The mortality ranged from 0.64–11.6% with highest being from Shimla. Accidental poisoning was common involving 50–90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra where probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background.
Profile of childhood poisoning at a tertiary care centre in North India
Indian Journal of Pediatrics, 2008
Objectives To determine the profile and outcome (discharge from emergency room after observation, admission or death) of pediatric patients presenting with acute poisoning to a tertiary care centre in north India. Methods We retrospectively reviewed the last 2 year (July, 2004 to July, 2006) hospital records of pediatric emergency room to profile all cases of pediatric poisoning during that period and noted their outcome. All cases age ≤ 12 years with definite history of poisoning were included. Results 111 patients presented to the pediatric emergency during the study period. Mean age of our patients was 3.12 ± 2.04 yrs (SD). Majority of our patients (63.9%) was in the 1–3 yr age group. Males outnumbered females by a factor of two; majority of our patients resided in urban areas. Kerosene (27.9%), drugs (19.8%) and insecticides (11.7%) were the agents most frequently implicated. Almost all (96.9%) ingestions were accidental in nature. Thirty six patients (32.4%) were asymptomatic after 6 hr of observation in the emergency ward; 75 patients (67.6%) developed symptoms related to toxic ingestion. The common serious symptoms included altered sensorium, respiratory distress, seizures, ataxia, hypotension, cyanosis and burns; three patients required intubation and mechanical ventilation. Almost one third of our patients underwent gastric lavage; no patient with kerosene poisoning or any other inappropriate indication underwent the same. Conclusion The trends for pediatric poisoning noted at our centre are not very different from those observed in hospital-based studies conducted more than a decade ago, despite the rapid socioeconomic development in our country. In sharp contrast to developing countries, where majority of poisonings are due to common non-toxic household products, most of our patients require hospitalization because of severe symptoms related to dangerous nature of toxins ingested. Consultation with the poison cell results in improved patient management.