A pattern of poisoning in children- an experience from a teaching hospital in southern India

A pattern of poisoning in childrenan experience from a teaching hospital in southern India Vijayalakshmi P1, V. Benakanal S.2*, B. Patil R.3, Manoj GM4, S. Kumar R.5 DOI: https://doi.org/10.17511/ijpr.2020.i06.09 1 Vijayalakshmi P, Assistant Professor, Department of Paediatrics, SHIMOGA Institute of Medical Sciences, Shivamogga, Karnataka, India. 2* Shreeshail V. Benakanal, Assistant Professor, Department of Paediatrics, SHIMOGA Institute of Medical Sciences, Shivamogga, Karnataka, India. 3 Ravindra B. Patil, Professor and HOD, Department of Paediatrics, SHIMOGA Institute of Medical Sciences, Shivamogga, Karnataka, India. 4 Manoj GM, Senior resident, Department of Paediatrics, SHIMOGA Institute of Medical Sciences, Shivamogga, Karnataka, India. 5 R. Vikram S. Kumar, Professor, Department of Pediatrics, Subbaih Institute of Medical Sciences, Shivamogga, Karnataka, India.


Introduction
Poisoning is an important emergency as well as a major problem in all age groups throughout the The pattern of Poisoning varies according to age, the nature, and dose of the poison and type of exposure [10]. Among the accidental poisoning, even though there is no significant decrease in the number, the pattern of poisoning has shown a change with new hazards constantly appearing due to the introduction of newer drugs and chemicals for domestic use, farming [11]. Therefore, a periodic review of current data on poisoning from various centers is essential for providing the ever-changing information [12]. With increasing urbanization and rapid socio-economic development in India during the last two decades, some change in pediatric poisoning profile and outcome is to be expected.
Understanding about nature and severity of poisoning is crucial for appropriate and effective management. General epidemiological data should be used to assist the emergency department on proper management of poisoning cases especially for effective preventive and therapeutic approaches [13].
No previous studies have been done on acute poisoning in children at our center. The present study was carried out in the department of Pediatrics of District Hospital, which is catering services to this entire district, including parts of neighboring districts with the aim of determining the profile and outcome of children presenting with acute poisoning and bites.

Fig-1: Age and sex distribution.
The median age of our patients was 5.2 years (range 0.75-12 years). The majority of cases were below 5 years (63 cases, 47.01%), followed by 5-10 years age group (57 cases, 42.54%) and least was above 10 years (14 cases, 10.45%). Age and sex distribution are shown in Figure 1. Table 1 demonstrates the details of poisoning agents. hours accounting for 21.05% (Table 2).     about twice as likely to suffer as girls [28]. The recent community health and injury surveys in Asia show that snakebite-related injury ranks as a leading cause of childhood morbidity and mortality in this region [29]. Shivamogga has recorded the highest snake bites (930) in 2019 in Karnataka Making antivenom much more widely available.
Better surveillance and reporting are necessary to assess the extent of this forgotten injury and to improve prevention strategies [10]. As play is an integral part of the child's life, most of the bite occurs during play or while doing household work. Due to low educational status and high family workload, children remain unobserved during playing and therefore more prone to such accidental bites. Exploratory nature of behavior in children with no sense of fear is also a contributory factor.
Symptomatology observed closely reflected the route of a toxic ingestion. Common symptoms noted in decreasing order of frequency were vomiting; pain and swelling at the bite site, respiratory distress, abdominal pain, fever, and altered sensorium. Inherent toxicity of substances commonly consumed by our patients could possibly explain these findings.
The mortality rate in the present was 2.24% which is well in range with other national studies. In India, the reported figures for fatal poisonings ranged between 0.6% and 11.6%, while in Viet Nam the reported case fatality rate was 3.3% [12,31]. There is a scope to reduce mortality rate as only 76% of children reported early (within 4 hours) to hospital and 20.89% had received primary emergency care before being referred to our tertiary center.

Limitations
The study was conducted in Shivamogga district government hospital which receives sick patients from surrounding 7 districts and has more than 1000 PICU admissions per year; hence the conclusions of the study can be extrapolated to large populations.

Conclusion
Accidental poisonings are common in children below 5 years of age when parents are less attentive. The age range of suicidal poisoning is widening, as low as 8 years. Mortality and morbidity are high in cases of delayed treatment. The most common agent implicated is snake bite. Parental education regarding poison proofing a child's environment and guidance at every school to help children deal with stressful situations would be apt preventive measures. The most important step is to bring the child to the hospital at the earliest to reduce the morbidity and mortality significantly.
What does this study add to the existing knowledge? Snakebite cases are more common than kerosene and turpentine poisoning with high mortality.
Awareness among the community for the avoidance of traditional treatment and to seek early medical intervention in snake bites is essential.   [Crossref] 07. Budnitz DS, Lovegrove MC. The last mile-taking the final steps in preventing pediatric pharmaceutical poisonings. J Pediatr. 2012;160(2)190-192. [Crossref]