Trend and outcome of acute poisoning case: an experience from emergency department of eastern Nepal

Authors

  • Rabin Bhandari Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Nepal
  • Rupak Bhandari Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Nepal
  • Pramendra Prasad Gupta Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Nepal http://orcid.org/0000-0002-0856-6207

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20175764

Keywords:

Emergency, Mortality, Outcome of poisoning, Poisoning, Trend of poisoning

Abstract

Background: Poisoning is common in Nepal. The objective of the study was to describe the profile of poisoning cases presenting to the emergency of a medical university in eastern Nepal. The specific focus was on to describe the presentation, demographics, delay to care and describe the triage parameters at presentation.

Methods: An observational study was done. The secondary data from case files of all poisoning patients starting February 2012 to March 2013 were analyzed after retrieving them from Hospital record.

Results: Poisoning constituted 3.89% of total emergency visits. Mean age was 24 years with female: male 1.32. Median time delay to presentation from the incident was 4 hours. Mortality rate was 5.1%, intubation rate 6.3%. Agricultural products ingestion (763/1399) was the commonest modality. The triage vitals were noted as median 110 mm of Hg (Q25, Q75 100, 120) for systolic blood pressure, median 87 mm of Hg (Q25, Q75 73, 93) for mean arterial pressure and median 97 (Q25, Q75 94, 98) for SPO2 by pulse oximetry. The level of consciousness was noted as alert (87.6%), response to verbal stimuli (3.7%), response to pain stimuli (7.1) and unconscious (1.6%). Comparison between mortality and no mortality groups showed significant difference for mean arterial pressure (n 1399, p<0.001, Kruskal Wallis Test), SPO2 (n 1399, p<0.001, Kruskal Wallis Test) and state of consciousness (n 1399, p<0.001, Chi Square test).

Conclusions: Agricultural products are commonest, drugs and unknown poisons are significant. A large proportion is still unknown poisoning. Triage parameters can help to identify patients in risk of high mortality. 

Author Biography

Pramendra Prasad Gupta, Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Nepal

Department of General Practice and Emergency Medicine

References

Pokhrel D, Pant S, Pradhan A, Mansoor S. A Comparative Retrospective Study of Poisoning Cases in Central, Zonal and District Hospitals. Kathmandu Univ J Sci Eng Tech. 2008;1(5):40-8.

Rai BK. An epidemiological study of poisoning and outcome of treatment in emergency ward of a tertiary care hospital in eastern region of Nepal. Health Renaissance. 2010;7(1):43-6.

Adinew GM, Woredekal AT, Devos EL, Birru EM, Abdulwahib MB. Poisoning cases and their management in emergency centres of government hospitals in northwest Ethiopia. African J Emergency Med. 2017;7:74–8.

Saglam ZA, Demir B, Ataoglu EH, Yenigun M, Temiz LU, Saler T. Causes of acute poisoning in adults:a retrospective study, in a hospital in Istanbul, Turkey. J Public Health. 2012;(20):59–63.

Health Profile: Nepal. World Health Rankings. WHO Report 2014. Available at: http://www.worldlifeexpectancy.com/country-health-profile/nepal. Accessed on 13 July 2017.

Karki RK, Risal A. Study of Poisoning Cases in a Tertiary Care Hospital. Kathmandu Univ Med J. 2012;10(4):70-3.

Baral D, Rajbhandari S, Shrestha A, Basyal B, Prasad PN. Acute poisoning cases in emergency department of tertiary level hospital, Kathmandu. JGPEMN. 2011:53-8.

Ouédraogo M, Ouédraogo M, Yéré S, Traoré S, Guissou IP. Acute intoxications in two university hospitals in Burkina Faso. African Health Sci. 2012(4):483-6.

Anthony L, Kulkarni C. Patterns of poisoning and drug overdosage and their outcome among in-patients admitted to the emergency medicine department of a tertiary care hospital. Indian J Critical Care Med. 2012;16(3):130-5.

Singh J, Kaur J, Kumar V, Shah KA, Tandon RN, Patil VR. Trends of Poisoning in a Tertiary Care Centre of North West Uttar Pradesh. J Indian Acad Forensic Med. 2015;37(4):394-9.

Unnikrishnan B, Singh B, Rajeev A. Trends of acute poisoning in south Karnataka. Kathmandu University Med J. 2005;3(10):149-54.

Teklemariam E, Tesema S, Jemal A. Pattern of acute poisoning in Jimma University Specialized Hospital, South West Ethiopia. World J Emerg Med. 2016;7(4):290–3.

Basnet B, Bhandari R, Moore M. Initial resuscitation for Australasian Triage Scale 2 patients in a Nepalese emergency department. Emergency Med Australasia. 2012(24):430–4.

Bharati U, Shrestha JB, Sharma M. Study of Acute Poisoning in Nepal Medical College Teaching Hospital. NMCJ. 2001;2:83.

Yadav RK. Ageing Population in Nepal: Challenges and Management. Academic Voices Volume. 2012(1);2:48-53.

Chalise HN. Demographic situation of population ageing in Nepal. Kathmandu University Med J. 2006;4(15):354-62.

Klein-Schwartz W, Oderda GM, Booze L. Poisoning in the elderly. J Am Geriatr Soc. 1983;31(4):195-9.

Sheetu MK, Jailkhani, Naik JD, Thakur MS, Langare SD, Pandey VO. Retrospective Analysis of Poisoning Cases Admitted in a Tertiary Care Hospital. Int J Recent Trends Sci Technol. 2014;10(2):365-8.

Gupta SK, Joshi MP. Pesticide poisoning cases attending five major hospitals of Nepal. J Nep Med Assoc. 2002;41:447-56.

Maskey A, Parajuli M, Kohli SC, Baral S, Basnet S, Poudel N. Scenario of poisoning cases in adults admitted in Manipal Teaching Hospital, Pokhara, Nepal. Nepal J Med Sci. 2012;1(1):23-6.

Joshi A, Awale P, Shrestha A, Lee M. Acute Mushroom Poisoning:A report of 41 cases. J Nep Med Assoc. 2007;46:7-12.

Syed VA, Lakshmi R, Karki P, Pradhan B, Maskey R. Scenario of mushroom poisoning in a tertiary care hospital. JNMA J. Nepal Med Assoc. 2009;48(176):296-300.

FitzGerald G, Jelinek GA, Scott D, Gerdtz MF. Emergency department triage revisited. Emerg Med J. 2010;27(2):86-92.

Van Spall HGC, Atzema C, Schull MJ, Newton GE, Mak S, Chong A et al. Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification. PLoS One. 2011;6(8):e23065.

Liu Y, Liu J, Fang ZA, Shan G, Xu J, Qi Z, et al. Modified shock index and mortality rate of emergency patients. World J Emergency Med. 2012;3(2):114-7.

Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. Hospital Chronicles. 2012;7(1) (suppl):114-7.

Sungurtekin H, Gurses E, Balci C. Evaluation of several clinical scoring tools in organophosphate poisoned patients. Clin Toxicol (Phila). 2006;44:121–6.

Eizadi-Mood N, Saghaei M, Jabalameli M. Predicting outcomes in organophosphate poisoning based on APACHE II and modified APACHE II scores. Hum Exp Toxicol. 2007;26:573–8.

Shadnia S, Darabi D, Pajoumand A, Salimi A, Abdollahi M, et al. A simplified acute physiology score in the prediction of acute organophosphate poisoning outcome in an intensive care unit. Hum Exp Toxicol. 2007;26(8):623–7.

Yu JH, Weng YM, Chen KF, Chen SY, Lin CC. Triage vital signs predict in hospital mortality among emergency department patients with acute poisoning:a case control study. BMC Health Serv Res. 2012;12:262.

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Published

2017-12-23

How to Cite

Bhandari, R., Bhandari, R., & Gupta, P. P. (2017). Trend and outcome of acute poisoning case: an experience from emergency department of eastern Nepal. International Journal Of Community Medicine And Public Health, 5(1), 66–71. https://doi.org/10.18203/2394-6040.ijcmph20175764

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Original Research Articles