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November 1988, Volume 38, Issue 11

Letter to the Editor

ACUTE POISONING IN ADULTS IN MULTAN

Sir,

Acute poisoning in adults and children accounts for significant morbidity and mortality, the world over. The Cleveland poison control centre in USA, which is one of the six centres for poison control, receives about 50,000 cases/year, indicating the high magnitude of problem. The incidence of poisoning has increased due to the changing socioeconomic pattern, drug explo­sion and use of chemicals in agriculture.
In Multan, of 59,216 admissions over a year (1986), 112 cases (0.19%) of acute poisoning were seen. This frequency is lower than 035% in Africa1, 3.5% in Pakistani children2 and 10  15% in American and European countries3. A high predominance of males (8: 1) was seen in the present study  with 80% cases belonging to upto 30 years of age  (Mean age 25.9 ± 9.2 years). Lower socioeconomic group was maximally affected. Both sexes are equally affected in other reported series1-4 with 68% cases belonging upto 30 years of age1-5 Mean hospital stay was 3.4 ± 2.2 days (range 1-15 days) with 20.4± 45.0 hours exposure time to poisonous substance prior to hospitalization. First symptom of poisoning appeared on an average of 2.5 ± 6.7 hours. Poisoning was accidental in 77%, suicidal in 18% and addiction/homicidal in 5% cases, as against 20-35% accidental in other studies1-2-6
The causative agents were insecticides or orgaaophosphorous compounds in 75% cases, Narcotics/tranquillizers 13.4%, Copper sulphate 4.5%, Kerosine oil in 2% and Nesslers reagent in 0.9%. The agent remained undetermined in 4.5% cases. Narcotics/tranquilizers in Britain account for 75% cases and salicylates for 12% 6
Only 3 (2.7%) cases died, all of whom had insecticide poisoning, accounting for 3.6% deaths due to insecticides. These figures are much less than 7.7% deaths reported from Sri Lanka. 5 In­secticides taken either accidentally (25%) or as suicidals (73%) are the major poisoning agents in Sri Lanka5. Although the causative agents remain the same, but the mode of poisoning is accidental (90%) in Pakistan, which can be prevented by adopting proper measures.

Department of Medicine, Nishtar Medical College, Multan.
Yours Sincerely,
Noor Ahmad Noot Abdul Wahid Qazi Ghulam Moheud Din Chaudhry Mohammad Masood M. Athar Hashmat Afzal Haq Asif

REFERENCES

1. Cardozo, L.J. and Mugerwa, R.D. The pattern of acute poisoning in Uganda. East Air. Med. J.,1972 ; 49: 983.
2. Sarwar, S.A. Accidental poisoning in children. Pakistan J. Med. Res., 1973;12:36.
3. Macleod, J. Davidson’s principles and practice of medicine. 14th ed. Edinburgh, Churchill Livingstone, 1984; p.701.
4. Saddique, M. Report on poisoning in children admitted to general paediatric ward. Khyber Med. J., 1985;44.
5. Davis, J.E. Changing profile of pesticide poison­ing. N. Engi. i.Med., 1987;316:807.
6. Kessel, N. Self-poisoning . Br. Med. L, 1965; 2: 1265.

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