European Journal of Cardiovascular Medicine

Recent literature indicates that acute poisoning is a leading cause of hospital admissions in emergency departments ^{[1, 2]} and a major contributor to morbidity and mortality in India, as well as a significant global health issue ^{[3 - 6]}. Acute poisoning can result from deliberate self-harm, accidental ingestion, or homicidal actions involving harmful substances, leading to illness, injury, or death. Many individuals choose poisoning as a method of suicide, preferring it over other means like hanging or burning, due to the perceived peaceful nature of death by poisoning ^[4]. However, such incidents might be preventable with timely and appropriate intervention ^[7].

Globally, the annual suicide rate is approximately 10.5 per 100,000 people ^[8]. Studies consistently show that insecticides and pesticides are the most commonly used agents in poisoning cases ^[4]. In regions like the North-eastern states of India, where agriculture is prevalent, pesticides are easily accessible and often used in suicide attempts ^{[9, 10]}. Additionally, rapid industrialization and advances in agriculture have increased the availability of various insecticides, further contributing to poisoning cases ^[3].

To effectively prevent and address poisoning, it is crucial to understand the intent behind the act and the type of poison involved. Poisoning deaths are considered unnatural and necessitate medico-legal investigation and post-mortem examinations. The pattern of poisoning cases is influenced by socioeconomic factors, religious and cultural beliefs, and the availability of poisons, all of which are important for managing and preventing such incidents.

The current research aims to examine the condition of poisoned patients admitted to a tertiary care hospital.

Study place: - The study was conducted in department of forensic medicine and anatomy in association with department of emergency department after taking permission from institutional ethical committee and after taking inform consent form from poisoned patient or patient attendant.

Study Design – The study was prospective, observational study, cross sectional study.

Sample Size – A total of 328 poison patients was included in the study.

Duration of study – The study was carried out over the period of two years. 

Selection criteria –

Inclusion criteria –

1. Patient of different poison.
2. Patient ready to give inform consent form.
3. Patients of all age groups.
4. Patient given complete to police after admitted in hospital.

Exclusion criteria –

1. Patient not ready to give inform consent form.
2. Patient does not inform to police.
3. Patient does not provide any documents relevant to poison intake.

Study groups –

The study was carried out in 382 poisons cases admitted in emergency department of tertiary care hospital. The study was carried out after taking permission form institute ethical committee and patient ready to give inform consent form. All the precaution to be taken for the poison patient was taken and make the poison out form the stomach. Physical examination like smell, symptoms was noted for the death patient biopsy was done to seen the organ damage.  Before conducting medical procedure, police case was done with proper criteria.

Statical analysis – the data was noted in MS-Excel office. Statical analysis was done by using SPSS Software. Percentage no of the patients was done.

Table No 1: Tabular column represents the gender wise distribution of poisoning cases.

Figure No 01: percentage difference in gender among poisoning cases

Table No 02: Tabular column represents the age wise distribution of poisoning cases.

Figure No 02 Percentage in Age Group of Poison Patients.

Table No 3 – Tabular column represents the types of poison conserved by patients.

Figure No 03 – graphical representation of percentage intake of poison by patients.

Table No 04 Intake of poison by accidental and suicidal

Figure No 04-percentage difference in intake of poison by accidental or suicidal.

Table No 05 – Tabular column represents the death of patients due to suicidal poisoning.

Figure No 05: Percentage in suicidal intake of poison.

Table No 06 – Symptoms of poisoning

Figure No 06 – Graphical presentation of percentage in symptoms due to poison intake.

Table No 07 – Tabular representation of external examination and postmortem after death among poison patients.

Figure No 07 – Graphical percentage in external observation among poison cases.

Figure No 08 graphical representation of postmortem among death poison patients.

Table No – 08 Tabular column represents the organ damage due to poison cases

Figure No 09 Percentage in organ damage after poison intake.

The study was conducted on 328 poison patients. The study was conducted after obtaining permission from the institutional ethical committee and the patient was ready to provide an informed consent form. Among them, 219 (66.78%) were male followed by female 109 (33.23%) (Table & Figure 01). As per the study, the majority of the patients were male. As per the age group of the patient majority of the patient are under group of 31 – 40 years 123 (37.50) followed by 21 – 30 years 99 (30.18%), 41 – 50 years 49 (14.93%), 51 – 60 23 (07.01%), > 60 years 15 (04.57%), 11 – 20 years 13 (3.96%) and 0 – 10 6 (1.82%) respectively (Table & Figure No 02). Excess intake of any substance may cause poison to the human. As per the data collected from the patients or patient attendants, the majority of the patients had Food poisoning 92 (28.04%), followed by Alcohol 84 (25.60%), Sleeping pills 68 (20.73%), Belladonna poisoning 31(9.45%), Cyanides 28 (8.53%), Petroleum distillates 12 (3.65%), Carbamate 08 (2.43%) and Organophosphate 05 (01.52%) (Table & Figure 03). The intake of poison might be suicidal or accidental. There are a total of 298 unintentional cases and 30 suicide cases. Among 298 accidental cases, majority were food poisoning cases 83 (27.85%) followed by Sleeping pills 69 (23.15%), Alcohol 44 (14.76%), Cyanides 36 (12.08 %), Belladonna poisoning 24 (8.05%), Petroleum distillates 18 (6.04%), Organophosphate 15 (5.03%) and Carbamate 9 (3.02%) and among 30 suicidal cases majority of the cases were taken sleeping pills 17 (56.66%) followed by cyanide 09 (30.00%) and alcohol 04 (13.33%) (Table & Figure No 04). Death of the patient was seen among suicidal cases. Among 30 (09.14%) suicide cases there were 06 (20.00%) death cases observed due to excess intake of sleeping pills 05 (83.33%) followed by cyanides 01 (03.33) respectively (Table & Figure No 5). To identify the type of poison there are different symptoms majority of the patients. There are 130 (39.63%) patients with symptoms and 198 (60.36%) without symptoms. Among 130 (39.63%) symptom patient’s majority of the patients had symptoms of Nausea and vomiting 31 (23.84%) followed by Abdominal Pain 29 (22.30%), Hypotension 18 (13.84%), Respiratory depression 17 (13.07%), Bitter smell 16 (12.30%), Acetone Smell 11 (08.46 %), Mydriasis 6 (04.61%) and bradycardia 2 (01.53%) respectively (Table & Figure 06). The poison patient's external examination 173 (52.74%) showed strains around lips and nostrils 93 (53.75%) was the major sign found among poison patients followed by the sign of inflammation 36 (20.80%), Smell 32 (18.49%), dryness of skin 12 (06.93%) and no sign of observation among 155 (47.25%) patients (Table & Figure No 7). The postmortem was done on dead patients after intake of poison. As per the study Oral cavity perforation, Stomach & Intestinal 6 (100.00%), oral cavity corrosion and stomach content 5 (83.33%) respectively (Table No 07 & Figure No 08). Due to poison intake, organ damage was observed with some lesions like inflammation, softening and ulceration in different organs like the oesophagus, stomach, and small and large intestine. The majority of the patients observed Inflammation in 142 (43.29%) in the oesophagus in 52 (38.02%) followed by small intestine 43 (30.28%), stomach 35 (24.62%) and large intestine 12 (08.45%), softening was observed 10 (03.04%) majority was observed in oesophagus 05 (50.00%) followed by stomach 04 (40.00%) and small intestine 01 (10.00%) and ulceration was observed in 60 (18.29%) majority was observed in stomach 38 (63.33%) followed by oesophagus 09 (15.00%), small intestine 12 (20.00%) and large intestine 01 (01.66%) respectively (Table No 08 & Figure No 09).

Our study coincides with the study by Goswami et al. (2021) ^[11], 244 out of 584 cases (41.8%) of suspected acute poisoning were found to contain toxic substances, with a predominance of male cases (62.29%). The highest incidence of acute poisoning occurred in the 21–30-year age group (33.6%), with 48 cases (31.6%) among males and 34 cases (36.9%) among females. Organophosphates (OP) were identified in 151 cases (61.9%), making them the most common cause of fatal poisoning, followed by carbamates in 45 cases (18.4%). Additionally, the study found that 76 cases (36.2%) of suicides were within the 21–30-year age group. Children and younger individuals were more susceptible to accidental poisoning, with 26.5% of such cases occurring in each of the 0–10 and 11–20-year age groups, and virtually no cases in those over 60 years. The findings highlight the need for targeted guidelines for the safe handling, storage, and transportation of toxic substances, with particular attention to adolescents and young adults. The prevalence of organophosphates in acute poisoning cases should be considered in managing and preventing poisoning incidents.

Study by Lalit P. Chandravanshi and Mamta Pal (2018) ^[12] explored various methods for diagnosing poisoning within the field of post-mortem toxicology, providing comprehensive guidance to determine the cause of toxicity. Accurate diagnosis of poisoning is crucial for effective toxicology management, particularly in cases involving unconscious individuals. It is essential to differentiate poisoning from other conditions because some clinical symptoms may stem from diseases or secondary effects like anoxia. Misdiagnosis can occur when poisoning symptoms mimic those of certain diseases, such as high doses of paracetamol, thallium, or paraquat, which can present with symptoms similar to hepatitis, paraesthesia, and pneumonitis, respectively. Diagnosing poisoning can be particularly challenging in death cases involving drugs intended to treat diseases but which may result in fatalities due to overdose or adverse side effects. This review aims to improve evidence-based knowledge for diagnosing poisoning in forensic toxicology, enhancing the accuracy and reliability of such diagnoses.

Patel DJ et al. (2011) ^[13] reported that 72.02% of cases were suicidal, 25.88% were accidental, and 2.10% were of unknown origin, which differs from our findings. The higher prevalence of cases from rural areas in our study aligns with a review, possibly due to the casual handling of pesticidal substances, given that agriculture is a major occupation in these rural regions (Dash SK et al., 2005) ^[14].

The patient who was poisoned by sleeping pills presented with symptoms of nausea and vomiting, as well as stains around the lips and nostrils. Postmortem examination revealed a range of inflammatory and ulcerative conditions.

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