Targeting 100% survival in toxicology cases

Dr pramod sarwa

Introduction Poison is a substance that causes damage or injury to the body and endangers one’s life due to its exposure by means

ofingestion, inhalation or contact (Thomas et al., 2004).

Acute poisoning is defined as acute exposure (less than 24hrs) to the toxic substance (Klassen et al., 1986).

Acute poisoning due to Accidental and suicidal exposure causes significant mortality and morbidity throughout the world According to the World Health Organization (WHO), 99 per cent of the fatal poisoning cases occur in developing countries, predominantly among the farmers due to various kinds of poisoning, including poisonous toxins from natural products during handling

Cont.. According to World Health Organization

(WHO), globally more than three million of acute poisoning cases with 2, 20,000 deaths occur annually (WHO1999).

It has been estimated that, in India five to six persons per lakh of population die due to acute poisoning every year (Narayana Reddy, 2010).

Poisoning is the fourth common cause of mortality in India (Unikrishnan et al., 2005)

Cont. According to various studies

organophosphate forms the commonest poisoning agent

(Adalkha et al., 1988; Jaiprakash et al., 2011; Jesslin et al., 2010; Vinay et al.,2008; Ramesha et al.,

2009).

Mortality in op 18to20% (indian J Anaesth. 2014 Jan-Feb; 58(1): 11–17.Survival pattern in patients with acute organophosphate poisoning on

mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital. ………..Syed m ahmed,bikramjit das, abu nadeem and rajiv k samal.)

Number of toxicology cases 74prospective study period = feb 13 to nov 14

unknown; 6; 8%

op; 19; 26%

celphose; 18; 24%

snake bite; 15; 20%

rat poison; 4; 5%

acid; 2; 3%

scorpion/bee/an-imal; 3; 4%

kerosene; 1; 1%miscell; 6; 8% poisoning cases

Sex distribution

unkno

wn op

celph

ose

snake

bite

rat po

ison

acid

scorpi

on/be

e/anim

al

kerose

ne

miscell

0123456789

10

4

10

89

2

01

0

42

89

6

2 2 2

12

malefemale

Ventilator required

2

8

7

111

2 1

6

19

18

15

42

3 1 6 unknownopcelphosesnake biterat poisonacidscorpion/bee/an-imalkerosenemiscell

HD/CRRT required

1

11

1

6

19

18

15

42

3 16

unknown

op

celphose

snake bite

rat poison

acid

scorpion/bee/an-imal

kerosene

miscell

icu stay

unkno

wn op

celph

ose

snake

bite

rat po

ison

acid

scorpi

on/be

e/anim

al

kerose

nemisc

ell0123456

avg icu stay in days

avg stay in days

Toxicology cases survival at JRCCTH

0

2

4

6

8

10

12

14

16

18

6

1817

15

4

23

1

6

3

18

8

15

4

21 1

6

number of casessurvived

Survival in toxicology cases at jrccth

OP……..100% Snake bite…100% Celphos…50% Acid ingestion..100% Rat poison ..100% Kerosene ..100% Unknown poison..50% Miscellaneous 100% (phenol,terpentine,

alcohol, neem, dhaturaNitrobenzene )

Year 2013 … 22 out 27

0

1

2

3

4

5

6

7

8

5

8

6

12

3

0

22

8

6

12

10

2

2013survival in 13

Year 2014…. 29 out 29

unkno

wn op

snake

bite

rat po

ison

acid

scorpi

on/be

e/anim

al

kerose

ne mis0

2

4

6

8

10

12

1

11

9

3

0 01

4

1

11

9

3

0 01

4

2014surival in14

celphos Bajwa SJ, Bajwa Kaur SK, Kaur J, Singh K, Panda A.

Management of celphos poisoning : A ray of hope in the

darkest of clouds. Anesth Essays Res 2010;4:20-4 survival rate 42% .

This poisoning has a high mortality (40–100%) and survival is unlikely if more than 1.5 g is ingested. the lethal dose is 150–500 mg for an adult  Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol (Phila) 2009;47:89–100. [PubMed

Celphose .. Old protocall

number of cases crrt/hd survived survived with RRT survived without RRT

0

2

4

6

8

10

12 11

5

3

1 1

before july14

before july14

Celphose ..new protocall

number of cases crrt/hd survived survived with RRT survived without RRT

0

1

2

3

4

5

6

7

76 6 6

0

after july 14

after july 14

Celphose cases survial

number crrt/hd survived survived with RRT

survived without RRT

0

2

4

6

8

10

1211

5

3

1 1

6

5 5 5

0

before july14after july 14

After july 2014.. 85.71%

cases

Targeting 100% survival in poisoning casescelphose

very aggressive management of metabolic acidosis

early institution of HD/CRRT/SLED massive bicarbonate therapy

Targeting 100% survival in poisoning cases op poisoning

Apart from decontamination , supportive treatment ,important role of

Early PCT Early mechanical ventilation PAM in non carbamate poisoning

Targeting 100% survival in poisoning cases Snake bite

ASV Early identification and management

of complication like intracranial hemorrhage coagulopathy muscle weakness necrosis

conclusion

Early identification Definitive care Early aggressive management Recognition of complications Management of complication Documentation