Naveen G Nadig1, Muganagowda Patil2 and Sachin KR3*
1Professor, Department of Pediatrics JJMMC Davangere, India
2Professor and HOD, Department of Pediatrics JJMMC Davangere, India
3Senior Resident, Department of Pediatrics JJMMC Davangere, India
*Corresponding Author: Sachin KR, Senior Resident, Department of Pediatrics JJMMC Davangere, India.
Received: November 26, 2020; Published: December 15, 2020
Citation: Sachin KR., et al. “Epidemiology, Clinical Profile and Immediate Outcome of Poisoning in Children in Tertiary Care Hospital”. Acta Scientific Paediatrics 4.1 (2021): 15-18.
Background and Objectives: Poisoning in pediatric age group is one of the most common emergencies encountered in pediatric practice. Poisoning in children are mostly accidental, and most cases are preventable. Surge in incidence of acute poisoning episodes are attributable to increased use of various chemical substances in households.
Objectives: To ascertain the epidemiology, clinical profile and immediate end result of children presented to PICU with acute poisoning in a tertiary care hospitals attached to JJMMC Davangere.
Materials and Methods: The study was an observational study conducted over a period of 1 year from December 1st 2017 to December 1st 2018 with 273 cases of poisoning in paediatric age group. Target populations were Children with poison intake history of with or without clinical features, with uncertain history of poisoning but with clinical features of acute poisoning.Relevant investigations were done whenever required. All the cases were managed according the latest standard guidelines. Data was tabulated and statistically analyzed.
Results and Interpretation: Out of 273 patients admitted 113 cases (41.39%) belonged to age group between 1 to 6 years of age. where males (141) outnumbered females (132). A total of 183 cases (67.03%) were due to accidental poisoning, 77 cases (28.20%) due to suicidal and 13 cases (4.76%) were due to homicidal poisoning. Out of all major toxic agents involved, hydrocarbons (144, 52.74%) were consumed among major number of children reported. Maximum i.e. 119 cases were due to kerosene poisoning followed by 56 cases due to OP compounds. Most common symptoms observed were vomiting in 203 patients followed by respiratory distress in 107 patients and altered sensorium was observed in 77 patients. Out of 273 poisoning cases, total mortality had been reported in 11 patients (4.02%), Out of 11 cases mortality due to OP compounds stand highest (5, 45.45%).
Conclusion: Parental awareness and education plays vital role in obviating the accidental poisoning in children.
Keywords: Poisoning; Kerosene; Accidental; Hydrocarbons; Vomiting; Altered Sensorium
WHO: World Health Organization; PICU: Pediatric Intensive Care Unit; ECG: Echocardiography; LFT: Liver Function Test; RFT: Renal Function Test; ABG: Arterial Blood Glass; OP: Organo Phosphate; MAO: Monoamine Oxidase; DDT: Dichlorodiphenyltrichloroethane; EEG: Electroencephalogram; BUN: Blood Urea Nitrogen; ABCD: Airway, Breathing, Circulation, Disability; HCN: Hydrogen Cyanide; BAL: British Anti–lewisite; EDTA: Ethylene Diaminetetraacetic Acid; GCS: Glasgow Coma Scale.
Increasing morbidity and mortality due to acute poisoning in children is a serious emerging challenge to pediatricians. Poisoning in children are mostly accidental and are preventable [1]. Poisonus substances accidentally consumed orally contributes to majority of cases and further supplemented by keeping toxic subatances in drinking water bottle or food containers which are often mistaken by children [2,3].
Environmental elements and variety of population, play a role in accidental poisoning. According to WHO reported incidence of childhood poisoning in various studies varies from 0.3% to 7%, and this contributes to a remarkable number of admissions to the PICU. Bapuji Child Health Institute and Research Center, Davangere is a Tertiary care hospital and poisoning in children accounts to 5-6% of PICU admissions annually.
To ascertain the epidemiology, clinical profile and immediate end result of children presented to PICU with acute poisoning in a tertiary care hospitals attached to JJMMC Davangere.
The present study was conducted on children upto 18 years of age admitted in tertiary care hospitals attached to JJMMC, between December 1st 2017 to December 1st 2018 with acute poisoning.
The present study was an observational study conducted over a period of 1 year from December 1st 2017 to December 1st 2018.
Children with poison intake history of with or without clinical features, with uncertain history of poisoning but with clinical features of acute poisoning.
Children with uncertain history of food poisoning and distinctive reactions to drugs were excluded from the study. In case of intoxication data regarding patient ,details related to poisoning ,clinical profile were documented systematically. Relevant investigations were done whenever required.
The current observational study with a total of 273 Children with poison intake history of with or without clinical features, with uncertain history of poisoning but with clinical features of acute poisoning were considered for statistical analysis. Out of all major toxic agents involved, Majority children i.e. 144 cases reported to hospital were reported with consumption of hydrocarbons (52.74%) followed by 100 cases reported with consumption of insecticides and pesticides (36.63%), 21 patients were reported with ingestion of drugs (7.69%) and 8 patients consumed cleansers and detergents (2.93%). Among insecticides and pesticides, 56 patients consumed OP compounds and constituted maximum number (56.00%) of cases followed by 29 cases with pyrethroids consumption (29.00%).Out of 273 poisoning cases, the mortality had been reported in 11 patients (4.02%). Out of 11 cases mortality due to OP compounds is 5 constituting 45.45% of mortality.
Poisoning in pediatric patients is a noteworthy cause of morbidity and mortality in India. It is responsible for 0.38% to 7.8% of total admissions in PICU at various hospitals across India. The inquisitive nature of toddlers makes them susceptible for accidental poisoning. The extent of contribution of childhood poisoning to total admission differs among institutions.In our present study population of 273, 113 cases (41.39%) belong to age group between 1 to 6 years of age which was similar to studies done by Kohli., et al. [4], Bhat., et al. [5] and Ratigeri., et al. [6]. Bandyopadhay., et al. [7] stated that poisoning among children were common between 12 to 18 years of age. This greater incidence of unintentional poisoning has been explained by inquisitive nature of toddlers with rapid neurological development [8-10]. Like many other studies all over the world ,the present study also showed increased male preponderance.
Out of 273 poisoning cases, 183 cases (67.03%) were due to accidental poisoning, 77 cases (28.20%) due to suicidal and 13 cases (4.76%) were due to homicidal poisoning. Out of all major toxic agents involved, hydrocarbons (144 Cases) was consumed by majority and constituted 52.74% of children reported to our hospital followed by insecticides and pesticides (100 Cases) constituting 36.63%, drugs (21 cases) constituting 7.69% and cleansers and detergents (8 Cases) constituted 2.93%.
Graph 1: Distribution of patients according to major toxic agents involved.
Among insecticides and pesticides, OP compounds were consumed by the maximum number (56) of cases 56% followed by pyrethroids (29) constituting, 29.00%. Among hydrocarbons, kerosene (119 cases, 82.63%) were consumed by the maximum number of cases followed by paint thinner (19 Cases, 13.19%).
Graph 2: Distribution of insecticides and pesticides poisoning patients according to the mode of poisoning.
In our study, the most common symptoms observed in patients were vomiting was observed in 203 patients (74.35%) followed by respiratory distress in 107 patients (39.19%) and altered sensorium in 77 patients (8.20%). Kohli U., et al. reported that approximately two thirds of their patients developed symptoms after poison ingestion that ranged from trivial to severe and life threatening; the remaining one third were asymptomatic. The common symptoms noted in decreasing order of frequency were vomiting, altered sensorium, respiratory distress and seizure. In contrast to reports from the developed countries, the majority (68.4%) of patients required hospitalization, and only one third of patients could be discharged after 6 hours of observation. Out of 273 poisoning cases, the mortality had been reported in 11 patients (4.02%) among our study population. Out of 11 cases expired, the mortality due to OP compounds stand highest (45.45%).
Graph 3: Mortality among the poisoning patients in our study population.
A telephonic consultation with the National Poisons Information Centre (NPIC), which is located at our centre, is obtained for all our poisoning patients after initial stabilization in the paediatric emergency room. This standard practice could account for the observation that none of our patients received any inappropriate intervention or therapy (e.g., gastric lavage for kerosene poisoning or lavage after more than 2 hours of poison ingestion).
While kerosene still remains the single most important cause of poisoning in our patients, no deaths were reported. Our findings concur with the findings reported in this study, with approximately 41.39% of our patients in this age group. The data from another large north Indian centre published about a decade ago suggested kerosene poisoning to be responsible for more than half of the paediatric poisonings. Our results suggest that kerosene poisoning, though decreasing in prevalence, still remains the single most important cause of paediatric poisoning in our population. In contrast to previous reports, our results show a worrisome increase in poisoning due to drugs.
Irrespective of the rapid socioeconomic development in our country ,the trends for pediatric poisoning have not changed over the years. In contrarily to developed countries, where the larger number of poisonings are due to common non-toxic household products. 15.01% patients do not develop symptoms, and up to three fourths of the symptomatic patients are discharged after a brief period of observation in the emergency ward, the most of our patients required hospitalization because of severe symptoms related to dangerous nature of toxins ingested. Most of our patients improved with conservative management highlighting the important role of good supportive care in the management of poisoned patients.
Parental awareness and education plays vital role in obviating the accidental poisoning in children.
Copyright: © 2021 Sachin KR., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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