Acute poisoning represents a critical medical emergency and a significant public health challenge globally, with a disproportionately high burden observed in developing nations such as India.¹ In India, the incidence of poisoning cases has been on a continuous rise, contributing significantly to hospital admissions and fatalities.²  In the Indian context, pesticides, particularly organophosphorus compounds, have consistently emerged as the predominant agents implicated in acute poisoning cases, largely due to their widespread availability and extensive use in agricultural settings.^3,4 The lethal risk of aluminium phosphide has repeatedly been emphasized across regions.^5,6 Beyond agricultural chemicals, other common agents include pharmaceutical drugs, household cleaning agents, plant-derived toxins, and corrosive substances, each contributing to the complex landscape of poisoning incidents.^7,8 Hospital-based Indian series consistently show that young, economically productive adults dominate admissions, with a male preponderance and significant rural representation—patterns that mirror national suicide surveillance indicating poisoning as the second most common method after hanging in 2022 (25.4% of all suicides).⁹

Studies from various parts of India consistently report a high prevalence of intentional self-harm as the primary manner of poisoning, often driven by underlying psychosocial stressors such as financial difficulties, interpersonal conflicts, and mental health issues.^8,10 This trend is particularly concerning among young adults, who represent a significant proportion of poisoning victims and are often in their most productive years.¹¹ Accidental poisonings, though less frequent in adults, remain a concern, especially with household chemicals and in pediatric populations.¹²

A prospective study in West Bengal (2025) highlighted the alarmingly high case fatality rate (74.28%) associated with acute paraquat poisoning.¹¹ This finding resonates with the broader concern regarding the easy accessibility of lethal agents. The present study aims to contribute to the existing body of knowledge by providing a detailed retrospective analysis of acute poisoning cases in tertiary care hospital, Patan, Gujarat.

Study Design and Setting: This was a hospital-based retrospective study conducted at a tertiary care hospital, Patan, Gujarat, India for period of 1 year (Jan 2024 to December 2024).

Sample size: The sample size for this retrospective study was determined by the availability of complete and accessible medical records of acute poisoning cases admitted during the defined study period. A total of 245 patients admitted to the tertiary care hospital with a diagnosis of acute poisoning during study period. Out of them, 15 patients were excluded due to incomplete or inaccurate data, ensuring that the final 220 cases included in the analysis were based on robust and reliable information. 

Study Participants: Cases were included irrespective of age, gender, or the specific type of poisoning agent involved. We excluded chronic exposures, food poisoning outbreaks without specific toxicant identification, and readmissions for the same index event.

Data collection and variables: From medical records and emergency logs, we extracted demographics (age, sex, residence), socio-economic status (operationalized via institutional criteria), index exposure characteristics (manner—suicidal/accidental/homicidal; time since exposure; timing—day/night), clinical severity at admission (categorized as mild, moderate, or severe), and disposition/outcomes (discharged, death, discharge against medical advice [DAMA], length of stay). Toxicant identification was based on history, container/label, clinician assessment, and available lab/toxicology where applicable.

Statistical Analysis: Descriptive statistics were used to summarize the socio-demographic characteristics, types of poisoning, and clinical profiles of the study population. Frequencies and percentages were calculated for categorical variables. Univariate associations with mortality were assessed using chi-square tests for categorical variables. A p-value of <0.05 was considered statistically significant.  Variables with p<0.10 on univariate screening and those of a priori clinical relevance were entered into a multivariable logistic regression model to estimate adjusted odds ratios (aORs) with 95% confidence intervals for mortality. Model diagnostics assessed collinearity and overall fit. All statistical analyses were performed using statistical software SPSS V.20.

Among the 220 poisoning cases studied, the most affected age group was 21–30 years (37.3%), followed by 31–40 years (23.6%). It indicates that poisoning predominantly affects young adults in their most productive years. There was a male predominance (62.7%) compared to females (37.3%). The majority of cases belonged to the lower socio-economic class (42.7%) and lower-middle class (27.7%). Most cases were from rural areas (72.3%), reflecting agricultural exposure and easy availability of pesticides in these communities [Table 1].

Table 1. Socio-demographic characteristics of poisoning cases (n=220)

Among the 220 cases, the most common agents were pesticides (55.0%), with organophosphates (30.0%) being the leading cause, followed by aluminium phosphide (16.4%). This reflects the widespread use and easy accessibility of pesticides in rural Gujarat. Plant-derived poisons accounted for 8.6% of cases, with Dhatura (2.3%) and Jatropha curas (3.2%) being the most frequent. Pharmaceutical drugs (9.5%) and corrosives (7.3%) were other important contributors, while animal envenomation (6.4%), alcohol intoxication (3.6%), and household chemicals (7.3%) formed smaller but significant categories [Figure 1].

Figure1. Distribution of poisoning cases by type of poison (n=220)

The majority of cases were suicidal in intent (76.4%), while accidental exposures accounted for 20.9% and homicidal only 2.7%. Most poisonings occurred during the evening/night hours (67.3%). A substantial proportion presented within 2–4 hours (35.5%), though 15.4% reached >6 hours after ingestion, which may have influenced outcomes. At admission, 41.8% of cases were mild, 34.5% moderate, and 23.6% severe. Hospital stay was ≤7 days in most cases (60.0%), while prolonged hospitalizations (>14 days) were relatively uncommon (15.4%). The majority of patients were discharged after recovery (80.0%), while mortality was 6.8%, and 13.2% left against medical advice (DAMA) [Table 2].

Table 2. Clinical and circumstantial profile of poisoning cases (N=220)

Mortality was significantly associated with older age (>60 yrs, 18.2%), lower socio-economic status (9.6%), type of poison (especially aluminium phosphide, 16.7% and corrosives, 12.5%), delayed presentation beyond 4 hours, and severe clinical condition at admission (19.2%). In contrast, gender, residence, manner of poisoning, and duration of hospital stay were not significantly related to mortality [Table 3].

Table 3. Factors associated with mortality in poisoning cases (n=220)

Severe poisoning at admission (aOR 6.5, p<0.001) and aluminium phosphide ingestion (aOR 4.8, p=0.002) were the strongest independent predictors of mortality, while delayed hospital presentation (>4 hrs) and lower socio-economic status also significantly increased risk. Age >40 yrs and corrosive ingestion showed a non-significant trend towards higher mortality [Table 4].

Figure 2. Multivariate logistic regression analysis of factors associated with mortality in poisoning cases

Table 4. Multivariate logistic regression analysis of factors associated with mortality in poisoning cases

This retrospective study provides valuable insights into the patterns, predictors, and outcomes of acute poisoning cases in Gujarat, contributing to the regional understanding of this significant public health issue.

Socio-demographic Profile: Present study showed that acute poisoning predominantly affected young adults aged 21–30 years (37.3%) and males (62.7%). This pattern is consistent with prior studies across India. Anandabaskar et al.¹⁰ (2019) in South India (32%), Bannur et al.⁷ (2019) in Belagavi (38.2%), Jailkhani et al.⁴ (2014) in Maharashtra (38.8%), and Kumar et al.² (2010) in Andhra Pradesh (≈66%) all reported similar age distribution. Male predominance, also seen in Mate et al.¹ (2017) (71.8%), Singh et al.¹³ (2016) (61.4%), and Nesam et al.³ (2021) (59%), is generally linked to occupational exposure, stress, and social pressures. Most cases were from rural areas (72.3%) and from lower socio-economic groups (42.7% lower, 27.7% lower-middle). Similar rural predominance was reported by Jailkhani et al.⁴ (2014) (67.4%) and Singh et al.¹³ (2016) (72.9%), often attributed to illiteracy, poverty, and agricultural chemical availability. The vulnerability of lower socio-economic strata, particularly for suicidal poisoning, has been repeatedly emphasized in Indian research.

Type of Poisoning Agents: Pesticides were the most common agents in present study (55.0%), with organophosphates (30.0%) and aluminium phosphide (16.4%) being the leading causes. This pattern is widely reported across India. Bannur et al.⁷ (2019) found pesticides in 49% of cases, and Nesam et al.³  (2021) identified rodenticide (rat killer) poisoning as the most common (33%), followed by insecticide poisoning (13.5%). Ramesha et al.⁸ (2009) in Karnataka also noted organophosphorus compounds as the majority (36.0%). The continued dominance of pesticides underscores the need for stricter regulations on their sale and storage, especially in agricultural regions. The high fatality associated with aluminium phosphide (16.7% mortality in our study) is particularly alarming and consistent with other reports highlighting its highly toxic nature and lack of specific antidote.^4,13 A recent study by Kotal et al.¹¹ (2025) from West Bengal further emphasized the high case fatality rate (74.28%) of paraquat poisoning, another highly toxic herbicide, reinforcing the call for banning such agents. Pharmaceutical drugs (9.5%) and corrosives (7.3%) were other significant contributors in our study. While pesticides are more prevalent in rural settings, pharmaceutical overdoses are often seen in urban areas.¹³ Mate et al.¹ (2017) also identified drug overdose (9.1%) as a notable category. The presence of plant-derived poisons (8.6%) like Dhatura and Jatropha curas reflects the use of traditional or easily accessible natural substances for self-harm or accidental exposure in the region.

Manner of Poisoning: The overwhelming majority of cases in our study were suicidal in intent (76.4%), with accidental exposures accounting for 20.9%. This finding is highly consistent with the general trend of poisoning in India. Anandabaskar et al.¹⁰ (2019) reported 75.3% suicidal cases, Bannur et al.⁷ (2019) found 67.1% suicidal cases, Jailkhani et al.⁴  (2014) observed 69.9% suicidal intent, and Nesam et al.³  (2021) noted 82% suicidal cases. The predominance of suicidal poisoning reflects underlying mental health and socio-economic stressors, while the higher occurrence during evening/night hours (67.3%) suggests vulnerability during periods of isolation or heightened emotional distress.

Clinical Presentation and Outcomes: In the present study, a substantial proportion of patients presented within 2–4 hours (35.5%), though 15.4% arrived after >6 hours. Delayed presentation critically influenced outcomes, as also reported by Mate et al.¹ (2017), who found longer lag times in deceased patients (median 385 vs. 120 min, p<0.014). Jailkhani et al.⁴  (2014) observed 76.2% of deaths with >2 hr delay, and Ramesha et al.⁸ (2009) similarly highlighted time lapse as a major mortality determinant. Ararame et al.¹² (2025) further stressed pre-hospital delays as key contributors to poor outcomes in their meta-analysis. At admission, 23.6% of cases were severe, which strongly predicted mortality (aOR 6.5, p<0.001). This aligns with Mate et al.¹ (2017), who reported higher Poison Severity Scores correlating with worse survival. Overall mortality was 6.8%, comparable to other Indian studies— Anandabaskar et al.¹⁰ (2019) (2.9%), Bannur et al.⁷ (2019) (11.4%), Nesam et al.³ (2021) (4%), and Kumar et al.² (2010) (8.3%) —with differences likely reflecting poison types, case severity, and available medical care.

Predictors of Mortality

Older age (>60 years) also showed a significant association with mortality, likely due to reduced physiological reserves and increased comorbidities, making them more vulnerable to the toxic effects of poisons. The influence of socio-economic status on mortality can be multifaceted, potentially reflecting delayed access to care, poorer nutritional status, and higher exposure to toxic agents in their living or working environments. This is consistent with national suicide surveillance highlighting the social gradient of poisoning suicides and with toxicoepidemiology from Indian hospitals emphasizing rural, low-income dominance among severe cases.^9,14 Targeted financial protection mechanisms (e.g., social insurance activation, fee waivers) and linkage to social work at triage could mitigate DAMA and improve survival. Delayed hospital presentation (>4 hours; aOR 2.9) independently increased mortality in present study, consonant with multicentre Indian observations that longer pre-hospital intervals steeply increase death risk (e.g., mortality >10% when admission is beyond 12 hours).¹⁵ Aluminium phosphide ingestion carried a four- to five-fold adjusted increase in death risk in present study, consistent with decades of Indian experience and recent risk-stratification literature documenting high mortality in aluminium phosphide, often exceeding 30–50% depending on dose, delay, and shock severity.^6,14

Multivariate analysis in present study identified severe poisoning at admission (aOR 6.5, p<0.001) and aluminium phosphide ingestion (aOR 4.8, p=0.002) as the strongest independent predictors of mortality. In contrast to some other studies, gender, residence, manner of poisoning, and duration of hospital stay were not significantly related to mortality in our multivariate analysis. While males and rural residents had a higher incidence of poisoning, their outcome was not statistically different from other groups after adjusting for other factors. This suggests that while these demographic factors influence exposure and presentation, the immediate clinical severity and the nature of the toxic agent are more critical determinants of survival. The lack of significant association with hospital stay duration might indicate that patients who survive beyond the initial critical period tend to recover, or that prolonged stays are not necessarily indicative of worse outcomes once the acute phase is managed.

LIMITATIONS

This study, while providing valuable insights, is subject to certain limitations. The study was conducted at a single tertiary care hospital in Gujarat, which may limit the generalizability of the findings to other regions or to the broader population of Gujarat, as patterns of poisoning can vary significantly based on local socio-economic, agricultural, and cultural factors. The study primarily focused on cases admitted to the hospital, potentially excluding minor poisoning cases managed at primary healthcare centers or those that did not seek medical attention, thus possibly underestimating the true incidence of acute poisoning. Psychiatric evaluation of suicidal patients was not performed, limiting insights into underlying causes.

This retrospective study underscores the significant burden of acute poisoning in Patan, Gujarat, predominantly affecting young adult males from rural and lower socio-economic backgrounds. Pesticides, particularly aluminium phosphide, remain the leading causative agents, often ingested with suicidal intent. The study highlights that severe clinical presentation at admission, ingestion of highly toxic agents like aluminium phosphide, and delayed presentation to healthcare facilities are critical independent predictors of mortality. These findings emphasize the urgent need for multi-faceted interventions, including stricter regulation and restricted access to highly lethal poisons, enhanced public awareness campaigns, improved pre-hospital care and transportation, and comprehensive mental health support, to effectively reduce the morbidity and mortality associated with acute poisoning in the region.

RECOMMENDATION

Based on the findings of this study, the following recommendations are proposed:

1. Regulation of Toxic Agents – Enforce stricter control on pesticide sale/storage, and restrict or ban highly lethal agents like aluminium phosphide without antidotes.
2. Community Awareness – Conduct rural health campaigns on poison risks, safe storage, and the need for urgent medical care.
3. Pre-hospital Care – Improve rural emergency medical services and transport facilities to reduce delays in reaching tertiary centers.
4. Healthcare Training – Regularly train providers at all levels in early recognition and management of poisoning.
5. Mental Health Support – Expand counselling and mental health services for young adults at risk of self-harm.
6. Socio-economic Measures – Strengthen community development programs to address poverty-related vulnerability.
7. Poison Information Centers –Sufficient stock antidotes at peripheral centres and establish regional poison-centre teleconsultation for front-line management;

ACKNOWLEDGEMENT

We would like to express their sincere gratitude to the medical records department of the tertiary care hospital, Patan, Gujarat for their invaluable assistance in providing the necessary patient data for this retrospective study. We also extend our thanks to all the healthcare professionals involved in the management of acute poisoning cases, whose dedicated efforts contribute significantly to patient care and outcomes.

1. Mate V, Dhande PP, Gonarkar SB, Pandit VA. A Prospective observational study on pattern, severity and outcome of different poisoning cases in a tertiary care hospital, India. J Basic Clin Pharm 2017 Jun;8154-7.
2. Kumar SV, Venkateswarlu B, Sasikala M, Kumar GV. A study on poisoning cases in a tertiary care hospital. J Nat Sci Biol Med. 2010;1(1):35–9.
3. Debbie Nesam JV, Ravindran MK, Asvini N, Pushpa B. a Clinical Therapeutic Correlation in Poisoning Cases - a Retrospective Analysis in a Tertiary Care Hospital. Indian J Appl Res. 2021;35–9.
4. Jailkhani SM, Naik JD, Thakur MS, Langare SD, Pandey VO. Retrospective analysis of poisoning cases admitted in a tertiary care hospital. Int J Recent Trends Sci Technol 2014;10(2)365-8.
5. Abdelghafar S, Farrag TA, Zanaty A, Alshater H, Darwish A, Hassanien AE. Pattern and predictors of death from aluminum and zinc phosphide poisoning using multi-kernel optimized relevance vector machine. Sci Reports 2023 May 22;13(1)8268.
6. El-Sarnagawy GN, Abdelnoor AA, Ghonem MM. Performance assessment of new poisoning mortality score and PGI score for predicting mortality in patients with acute aluminum phosphide poisoning. Hum Exp Toxicol 2024 Nov 11;4309603271241302208.
7. Bannur V, Jirli PS, Honnungar RS, Koulapur V V., Pujar SS. Pattern of poisoning cases at a tertiary health care centre– A cross sectional study. Medico-Legal Updat. 2019;19(1):124–9.
8. Ramesha KN, Rao KBH, Kumar GS. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India. Indian J Crit Care Med. 2009;13(3):152–5.
9. Rathod JS, kyada H. Trends of poisoning in rajkot region- a retrospective study. Int J Forensic Med Toxicol Sci 2019; 4(4)102-4.
10. Anandabaskar N, Murugan R, Selvaraj N, Jayaraman M, Rajamohammad MA, Kagne RN. A retrospective analysis of acute poisoning cases admitted to a tertiary care hospital in South India. Int J Basic Clin Pharmacol. 2019;8(10):2271.
11. Kotal S, Chatterjee S, Pain S, Kundu AK. A Prospective Study to Assess the Profile and Outcome of Acute Paraquat Poisoning in a Tertiary Care Hospital of West Bengal. Indian J Crit Care Med 2025 Aug 18;29(8)677-83.
12. Ararame GG, Senbeta BS, Chereka AA. Prevalence and determinant of poor treatment outcome of poisoning in Ethiopia: systematic review and meta-analysis. BMC Emerg Med 2025 Apr 15;25(1)62.
13. Singh DRR, Kumar DA, Uraiya DD, Dhaon DP. Retrospective analysis of poisoning cases admitted in a tertiary care hospital in North Eastern UP, India. Int J Med Res Rev. 2016;4(7):1172–7.
14. Aggarwal N, Sawlani KK, Chaudhary SC, Usman K, Dandu H, Atam V, Rani S, Chaudhary R. Study of pattern and outcome of acute poisoning cases at tertiary care hospital in North India. J Fam Med Prim care 2023 Sep 1;12(9)2047-52.
15. Krishnasamy N, Narmadhalakshmi R, Prahalad P, Jayalakshmi R, Lokesh R, Ramesh J, Reddy GM, Durai L. Determinants of poison-related mortality in tertiary care hospital, South India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publicat. 2024 Mar 30;28(4)329.