A study of clinical profile and outcome in the patients admitted with OP poisoning at tertiary health care center

 

Ramdas Bokil

 

Associate Professor, Department of Medicine, MIMSR Medical college and YCR Hospital, Latur, Maharashtra, INDIA.

 

Abstract              Background: Organophosphorous compounds are principally used as pesticides, and their exposure is highly prevalent in developing countries. Aims and Objectives: To Study Clinical profile and outcome in the patients admitted with OP poisoning at tertiary health care center. Methodology: This was a cross-sectional study carried out at the Department of Medicine in the Patients who were admitted to Intensive care unit of Medicine department with history of Organophosphorus poisoning during one-year period i.e. January 2015 to January 2016. Results: The majority of the patients were in the age group of 20-40 were -42.37% followed by 40-50 -23.73%,50-60 -18.64, >60 -11.86, <20 were 3.39%. The majority of the patients were Female i.e. 64.41% followed by Male i.e. 35.59%. The most common complaint was Nausea-90%. Followed by Vomiting in 80 %, Perspiration in 60 %Salivation in 53%, Altered sensorium in 42%, Convulsion–Respiratory difficulty in 35%, Twitching/flickering in 25%, Stool/urine incontinence in 17%. The majority of the patients were with Mild Severity of Poisoning i.e. 37%, followed by Moderate i.e. 15%, and Severe in 7%. As per the outcome of the patients Majority of the patients Survived i.e. 82%, followed by Death in 11% and DAMA in 7%. Conclusion: it can be concluded from our study that the majority of the patients were in the young age group , the most common presenting problem was Nausea , Vomiting, Perspiration, Salivation, Altered sensorium, Convulsion – Respiratory difficulty etc. The death rate was found to be 11%.

Key Word: OP poisoning, Choline esterase, Muscarinic symptoms, Nicotinic symptoms.

 

INTRODUCTION

Organophosphorous compounds are principally used as pesticides, and their exposure is highly prevalent in developing countries. Toxic effects of organophosphorus compound are associated with significant morbidity and mortality making it a major global clinical problem. Their ease of access and socio– cultural factors play important role in the choice of organophosphorus compound as a self-poison. The incidence is higher in young, economically active group with a case fatality ratio of 4-30%.^1,2,3 The importance of pesticides in India can be understood from the fact that agriculture is a major component of the Indian economy. It contributes 22% of the nation’s GDP and is the livelihood of nearly 70% the country’s workforce⁵.In India, use of insecticides, accounted for 67% of the total pesticide consumption in 2006. The potential adverse impact on human health from exposure to pesticides is likely to be higher in countries like India due to easy availability of highly hazardous products and low risk awareness. Overexposure to pesticides can occur before spraying because of easy access for children, lack of adequate labeling and during mixing, spraying and after spraying operations. Spray operators and bystanders can be affected. Suicidal poisonings are common as pesticides are cheap and easily available in market.⁴

 

METHODOLOGY

This was a cross-sectional study carried out at the Department of Medicine in the Patients who were admitted to Intensive care unit of Medicine department with history of Organophosphorus poisoning during one-year period i.e. January 2015 to January 2016. The details of the patients like age, sex, Clinical features, severity based on serum choline esterase level into Mild-(>800 U/L), Moderate-(400–800 U/L), Severe-(<400 U/L). All the patients were treated by standard protocol and severity of the poisoning. The outcome of the patients like Survived, Death and Discharged against Medical advice (DAMA) was noted. The data was presented in tabular form and expressed in Percentages.

 

RESULT

Table 1: Distribution of the patients as per the Age

The majority of the patients were in the age group of 20-40 were -42.37% followed by 40-50 -23.73%,50-60 -18.64, >60 -11.86, <20 were 3.39%.

 

Table 2: Distribution of the patients as per the Sex

The majority of the patients were Female i.e. 64.41% followed by Male i.e. 35.59%.

 

Table 3: Distribution of the patients as per the presenting problems

The most common complaint was Nausea - 90%. Followed by Vomiting in 80 %, Perspiration in 60 % Salivation in 53%, Altered sensorium in 42%, Convulsion–Respiratory difficulty in 35%, Twitching/flickering in 25%, Stool/urine incontinence in 17%.

 

 

Table 4: Distribution of the patients as per the Severity of Poisoning

The majority of the patients were with Mild Severityof Poisoningi.e. 37%, followed by Moderate i.e.15%, and Severe in 7%.

 

Table 5: Distribution of the patients as per the Outcome

As per the outcome of the patients Majority of the patients Survived i.e. 82%, followed by Death in 11% and DAMA in 7 %.

 

DISCUSSION

WHO estimated that approximately 3 million pesticide poisoning occurs worldwide and cause more than 2,20,0000 deaths per year Developing countries report alarming rates of toxicity and death.⁶ Because the OP compounds are readily available and relatively cheap and having rapidly lethal action even in smaller doses, they are widely used as suicidal poisons⁷ Suicidal poisoning with OP compound is seen with increasing frequency and carries 4- 30% mortality in Indian studies.⁸ Most of the fatality rate is of intentional poisoning by OP compounds, which has been reported in southern and central India.⁹ In our study we have seen that The majority of the patients were in the age group of 20-40 were -42.37% followed by 40-50 -23.73%,50-60 -18.64, >60 -11.86, <20 were 3.39% these findings are similar to ^{10,11,12,13, 14,15, 16}. The most common complaint was Nausea-90%. Followed by Vomiting in 80%, Perspiration in 60% Salivation in 53%, Altered sensorium in 42%, Convulsion–Respiratory difficulty in 35%, Twitching/flickering in 25%, Stool/urine incontinence in 17%. The majority of the patients were with Mild Severity of Poisoning i.e. 37%, followed by Moderate i.e. 15%, and Severe in 7% As per the outcome of the patients Majority of the patients Survived i.e. 82%, followed by Death in 11% and DAMA in 7 %. These findings are similar to Kailas N. Chintale et a ⁵ They found incidence of acute pesticide poisoning was 0.36% of total hospital admissions. Pesticide poisoning was more common in males (74.26%) than females (25.73%) with M: F ratio of 2.9:1.82. 35% were suicidal cases followed by accidental cases 13.97% and only 3.67 were homicidal. Incidence of suicidal and accidental poisoning was more common in married population (75.73%). History of social and domestic problems (50.80%), alcohol abuse (13.39%) and marital friction (11.60%) were common risk factors. Ingestion route of poisoning was most common (71.73%). Excessive salivation was the most common symptom observed in 72.05%.

 

CONCLUSION

it can be concluded from our study that the majority of the patients were in the young age group , the most common presenting problem was Nausea , Vomiting, Perspiration, Salivation, Altered sensorium , Convulsion–Respiratory difficulty etc. The death rate was found to be 11%.

 

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