A Clinico-Epidemiological Study on Pesticide Poisoning

Objective: To investigate the clinico-epidemiological aspects and to evaluate the immediate outcome of patients admitted with pesticide poisoning. Methods: Over a period of one year between January 2004 and December 2004, victims of pesticide poisoning admitted to one medical indoor department of Dhaka Medical College Hospital, Dhaka were enrolled. The diagnosis was based on history of pesticide ingestion and clinical features or with evidence of a brought specimen. The age, sex, marital status, occupation, cause of intoxication, poison consumed, time elapsed between ingestion and admission to the hospital, signs and severity of intoxication on admission, treatment and outcome were recorded on a pre-designed case record form. A total of sixty patients with pesticide poisoning were enrolled. After giving gastric lavage in the emergency department, all patients with suspected OPC poisoning were managed with atropine, prali-doxime and other supportive treatment also given. Results: The number of pesticide poisoning cases was 60 (1.37%) out of 4, 378 admitted patients. The mean age was 23.38 plus or minus 1.16 years. There were 24 (40%) males and 36 (60%) females, with male: female ratio being 2:3. 26 (43%) patients came from urban area and 34 (56%) patients from rural area. Incidence was high among students 21 (35%) and housewives 18 (30%). The most common reason for poisoning was suicide - 56 patients (93.3%). Sudden anger was the cause of suicide in 32 (53.3%) patients. 22 patients (36%) purchased poison over the counter and 28 (46%) patients used prior purchased poison for household use. The brand of poison was identified to 50% cases. The most commonly involved compound was malathion 15 (50%) patients. Only 15 (25%) patients presented within 2 hours of ingestion. All patients were managed with intravenous atropine. Pralidoxime was used in 38 (63.4%) cases. The mean amount of atropine used was 245.22 ampoules. The duration of hospital stay among the survivors was more than 5 days in 30 (63%) cases. The overall mortality was 21.7%. Majority of patients (9, 69.23%) died within the first 24 hours of admission. Conclusion: Acute pesticide poisoning is one of the commonest causes of death in the medical ward. To reduce this mortality proper management guidelines, proper training of physicians and other healthcare workers could be sought. More research work should be performed to determine the best therapy and improve survival.