¹Assistant Professor, ²Associate Professor, Department of General Medicine, Mahavir Institute of Medical Sciences (MIMS), Shivareddypet(V), Dist. VIKARABAD 501102, Telangana, INDIA.

Email: panditkdeshmukh@gmail.com

RESULTS

Among the study population, majority of them (59%) belonged to 21-30 years and majority of them were males (71%) (Table 1).

Table 1: Descriptive analysis of socio demographic parameters in study population (N=100)

Regarding the type of OP consumed 19 (19.0%) had consumed Methyl Parathion, followed by 18 (18.0%) consuming Clorpyriphos, 9 (9.0%) had taken Dichlorvas, 6(6%) while the status of 38 (38.0%) participants was unknown. The concentration these chemicals in 5 (54.0%) the participants was less than 50ml, 21 (21.0%) had consumed 50 to 100ml and only 1 (1.0%) person consumed more than 100 ml. The mode of OP intake was oral in 99% of them with one inhaling it (Table 2).

Table 2: Descriptive analysis of details of poisoning in study population (N=100)

Majority 67 (67.0%) of the participants reached the hospital within six hours while 22 (22.0%) reached in 7 to 12 hours and 11 (11.0%) reached the hospital after 12 hours. The severity of the poisoning was grade 1 in 49%. Grade 2, 3 and 4 poisoning were observed in 26%, 235 and 6% of the population respectively. Among the study population, 40 (40.0%) participants received <500 units of Pseudo cholinesterase dose, 25 (25.0%) of them were given 1000 to 5000 units and 17 (17.0%) received more than 5000 units of the dose. Among the study population in 25 (25.0%) participants GCS score was <10 and in 75 (75.0%) participants it was >10. The proportion of people met with mortality was 17% among study population (Table 3). There was an increasing trend of mortality with increasing age group till 41 to 50 years. Only 7.7% died in 18 to 20-year age group and 66.7% died in 41 to 50- year age group. The proportion of deaths in 51 to 60-year age group was slightly lesser at 40%. There was a statistically significant association between outcome and age groups (P value 0.031). Among 71 males, 57 (80.3%) were survived and 14 (19.7%) were dead. Among 29 females, 26 (89.7%) were survived and 3 (10.3%) were dead. The difference in the proportion of outcome between gender status was statistically not significant (P value 0.257). In < 6 hours pre-hospitalized participants, 55 (82.1%) were survived and 12 (17.9%) were died, 22 (100.0%) were survived and 0 (0%) were died in 7 to 12 hours pre-hospitalized participants 6 (54.5%) were survived and 5 (45.5%) were death in >12 hours. The difference in the proportion of outcome between pre-hospitalization status was statistically significant (P value <0.004). Among 57 participants who consumed < 50ml poison, 49 (90.8%) participants were survived and 5 (9.2%) participants were died. in 21 members who had 50 to 100ml poison 15 (71.42%) were survived and 6 (28.5%) were died, the person who consumed >100ml of poison was survived. Among 24 participants who consumed unknown 18 (75.0%) were survived and 6 (25%) were died. The difference in the proportion of outcome between amount of poison consumed in ml status was statistically not significant (P value 0.134). Among 40 participants who received <500 pseudo cholinesterase, 32 (80%) participants were survived and 8 (20%) were died, among 18 participants of 500 to 1000 dosage group 17 (94.4%) were survived and 1 (5.5%) were died. In 1000 to 5000 dosages group 19 (76%) were survived and 6 (24%) were died. Among 17 participants who received >5000 pseudo cholinesterase, 15 (88.2%) participants were survived and 2 (11.8%) were died. The difference in the proportion of outcome between pseudo cholinesterase status was statistically not significant (P value 0.372) (Table 4).

Table 3: Descriptive analysis of various parameters in the study population (N=100)

Table 4: Factors associated with mortality in study population

DISCUSSION

The mean age of the patients presenting to our emergency department was 30.07±10.91 years. Majority of cases presented were in age group of 21-30 years (59 %) and least was in age group of 61-70 years (3%). Added to the largely younger population being affected, is their absence of any co-morbidities there by leading to loss of productivity. These findings are in line with that of Akdur O et al, Thunga G et al and Nilamadhab K, Kora S A et al. Another study by Rao et al, revealed that about two-third of the patients, admitted in Warangal due to acute exposure of OP poisoning were less than 30 years.⁶ A significant difference was observed in the gender of the study population with 71% males and 29% females. This is in concurrence with that reported by Sam et al, where in 76% were males and 24% were females and the studies by Thunga G et al, Nilamadhab K. Contrastingly a female preponderance was observed in the studies by Akdur O et al, Kora S A et al and Banerjee I et al.⁷ The average pre-hospitalization time was higher in our study as compared to other studies where in the mean time lapse was 6.43±4.80 hours while the median was 5 hours. A relatively lower mean time lapse of 4 hrs each was found in the studies by Banerjee I et al, and Kora SA et al, while it was 3hrs in that of Thunga G et al.⁸ This time delay also can be due to the fact that patients are referred from a lower centre where first aid (e.g. stomach wash, first dose of atropine etc.) was done to control poisoning effects to some extent and also due to the issues related to longer distance and transportation to the tertiary hospital. This could also be a limitation of our study as these measures were not recorded in the peripheral centres its effects cannot be explained in this study.^9,10,11 The type OP compound consumed could only be ascertained only among 62% cases, in which the commonest compound consumed was Methyl Parathion followed by Clorpyriphos.^12,13 Methyl Parathion was also the most common compound consumed in the studies by Sam KG et al, Thunga G et al and Bannergee I et al. In studies done by Akdur O et al and Davis et al commonest compound was clorpyriphos. 21 Of the 100 patients, 69% survived without intubation, 14% patients survived but required intubation and prolonged ICU stay and 17% patients died even with intubation. The proportion of mortality cases was higher compared to that of Sam KG et al, Akdur O et al and Davis et al.¹⁴  Another notable finding of the study was that the outcome was significantly associated with the age with most of the younger subjects surviving while the mortality was high as the age increased notably those above 30years of age. A relatively higher proportion of deaths were observed among males (19.7%) than females (10.3%), though the difference was not significant. A similar higher preponderance of male deaths with a ratio of 2.7:1 were reported by Kar N, that could suggest that OP poisoning is more prevalent among males especially in hospital settings.¹⁵

CONCLUSION

It can be concluded that OP poisoning is more common among younger population, below 30 years with male preponderance. Hence efforts to decrease the elapsed between intake of poison and initiation of specific treatment may help to minimize the chance of death in some.

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