Outcomes of patients with self-posioning with organophosphorous pesticides at a rural tertiary care hospital in Southern India
Keywords:Organophosphate, Carbamate, Suicide, Poisoning
Background:Organophosphate (OP) pesticides are the main agents for pest control in agricultural crops making them the agent of choice for self-poisoning. In India, self-poisoning with OP pesticides is the second most frequently reported method of suicide owing to its ready and easy availability with mortality varying from 12% to 50%.
Methods: A retrospective study was conducted over a period of one year to compare the socio-demographic variables with the outcomes in patients with OP poisoning. A total 94 patients were consecutively included in the study and a statistical analysis was carried out.
Results: Majority of the patients belonged to the 21-30 years age group (54.3%), emphasizing the involvement of the young and productive age group into suicidal attempts. The study population consisted of 58 males (61.7 %) and 36 females (38.3%) depicting a higher incidence of OP poisoning amongst males. There was an overall mortality of 3.2 % amongst the treated patients. Females had a higher mortality (5.6%) as compared to males (1.7%). It was observed that the mortality was the maximum among the 41-50 years age group patients (p = 0.007).
Conclusions: Self-poisoning with OP pesticides is highly prevalent in the rural areas due to the ease of availability of these compounds and lack of regulatory control over the same. The young population is the most commonly affected by this. Regulation in sales and distribution of pesticides should be taken as a priority and early treatment yields a favourable outcome in majority of the patients.
Kishi M, Ladou J. International pesticide use. Int J Occup Environ Health. 2001;7:259-65.
Jeyaratnam J. Acute pesticide poisoning: a major global health problem. World Health Stat Q. 1990;43:139-44.
WHO. Health implications from monocrotophos use: a review of the evidence in India. South-East Asia. World Health Organisation. 2009:1-60
Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. Q J Med. 2000;93:715-31.
Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol. 2003;32:902-9.
Eddleston M, Phillips MR. Self-poisoning with pesticides. BMJ. 2004;328:42–4
World Health Organization. Epidemiology of pesticide poisoning: harmonized data collection of data on human pesticide exposure in selected countries. Geneva: International Programme on Chemical Safety/WHO, 2004.
Vale JA. Toxicokinetic and toxicodynamic aspects of organophosphorus insecticide poisoning. Toxicol Lett. 1998;102:649-52.
Hundekari IA, Suryakar AN, Rathi DB. Acute organo-phosphorus pesticide poisoning in North Karnataka, India. Oxidative damage, haemoglobin level and total leukocyte. African Health Sciences. 2013;13(1):129-36.
Thundiyil JG, Stober J, Besbelli N, Pronczuk J. Policy and practice. Acute pesticide poisoning: a proposed classification tool. Bulletin of the World Health Organization. 2008;86:205-9.
Eddleston M, Buckley NA, Checketts H, Senarathna L, Mohamed F, Rezvi Sheriff MH, et al. Speed of initial atropinisation in significant organophosphorus pesticide poisoning: a systematic comparison of recommended regimens. J Toxicol Clin Toxicol. 2004;42(6):865-75.
Ashani Y, Bhattacharjee AK, Leader H, Saxena A, Doctor BP. Inhibition of cholinesterases with cationic phosphonyl oximes highlights distinctive properties of the charged pyridine groups of quaternary oxime reactivators. Biochem Pharmacol. 2003;66:191-202.
Cherukuri H, Pramoda K, Rohini D, Thunga G, Vijaynarayana K, Sreedharan N et. al. Demographics, clinical characteristics and management of herbicide poisoning in tertiary care hospital. Toxicol Int. 2014;21(2):209-13.
Yamashita M, Yamashita M, Tanaka J, Ando Y. Human mortality in organophosphate poisoning. Vet Hum Toxicol. 1997;39:84-5.
Munidasa UA, Gawarammana IB, Kularatne SA, Kumarasiri PV, Goonasekera CD. Survival pattern in patients with acute organophosphate poisoning receiving intensive care. J Toxicol Clin Toxicol. 2004;42:343-7.
Liu S, Lin J, Shen H, Chang C, Huang W, Weng C et al. Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus. Environmental Health. 2014;13:11.
Cander B, Dur A, Yildiz M, Koyuncu F, Girisgin AS, Gul M, et al. The prognostic value of the Glasgow coma scale, serum acetyl cholinesterase and leukocyte levels in acute organophosphorus poisoning. Ann Saudi Med. 2011;31(2):163-6.
Ahmed SM, Das B, Nadeem A, Samal RK. Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital. Indian J Anaesth. 2014;58:11-7.
Rane A, Nadkarni A. Suicide in India: a systematic review. Shanghai Archives of Psychiatry. 2014;26(2):69-80.
Leibson T, Lifshitz M. Organophosphate and carbamate poisoning: review of the current literature and summary of clinical and laboratory experience in Southern Israel. IMAJ. 2008;10:767-70.
Maracek J. Culture, gender, and suicidal behaviour in Sri Lanka. Suicide Life-Threatening Behav. 1998;28:69-81.
Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World report on violence and health. Geneva: WHO, 2002.