Emerging Trend of Acute Poisonings Presenting to an Emergency Department in South India

Sir, The emergency department (ED) at Jawaharlal Institute of Postgraduate Medical Education and Research plays a pivotal role in addressing public health challenges, notably in the management of poisoning cases. Our ED Information and Management System (EDIMS) has been operational for the past two years, proving to be a robust and instrumental tool in patient management strategies within our department.[1] Utilizing data from EDIMS, from June 2022 to May 2023, we conducted a comprehensive review of all poisoning cases encountered in our ED, aiming to understand the incidence and trends during this period. The retrospective analysis of EDIMS data revealed a total of 1995 cases of poisoning over this stated 1-year duration, encompassing a broad spectrum of cases [Figure 1]. The data revealed the following types of poisonings: rodenticide poisoning 424 (24.89%), organophosphorus poisoning 228 (13.50%), yellow oleander poisoning 216 (12.74%), multiple tablet poisoning 98 (5.84%), ant killer poisoning 67 (3.95%), paraquat poisoning 38 (2.30%), other insecticide poisoning 38 (2.30%), other poisonings 584 (34.48%) which include paracetamol poisoning, corrosive poisoning (phenol, detergent, other acid and alkali), herbicides, and unknown poisonings. The findings provide critical insights into the local patterns and risks associated with poisoning, contributing to our understanding of regional trends and public health needs. The diverse range of poisoning cases observed underscores the complexity and variability of this health issue. The most frequently encountered poisoning was rodenticide, primarily from ingesting rat killer products like paste and cake, commonly sold under the brand name "Ratol" in South India, especially Tamil Nadu. A previous multicenter study in Tamil Nadu reported that 97.6% of all toxin-induced liver injury was due to rodenticide ingestion, with a rodenticide: paracetamol poisoning ratio of 75:1,[2] and rodenticide (phosphorous) ingestion in Tamil Nadu is equivalent to paracetamol overdose in the West. This is unlike the trend observed in other parts of the country where anticholinesterase poisoning was most prevalent.[3,4] Interestingly, the most common constituent observed in rodenticide poisoning cases at our center was also yellow phosphorous, mirroring the Tamil Nadu study results. The Tamil Nadu state government has identified this change in trend, and, in March 2023, banned its use by bringing about a legislative circular.[5] Following rodenticide poisoning, the second and third most common causes were organophosphorus poisoning and snake bites, respectively. Another striking difference in trend from national data was the increased incidence of plant poisonings, especially yellow oleander, a cardiac glycoside that needs management with digoxin antibodies and transvenous pacing. Our experience with EDIMS has not only facilitated efficient data collection and analysis but also enhanced our ability to respond to and manage such public health challenges effectively. These data reaffirm the importance of robust poisoning registries and setting up regional poison information centers in understanding and addressing the dynamics of acute poisoning.Figure 1: Incidence of acute poisoning cases presenting to the emergency department from June to May 2023. (Others* include paracetamol poisoning, corrosive poisoning (phenol, detergent, other acid, and alkali), herbicide, unknown poisoning; each <2%)Research quality and ethics statement The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines during the conduct of this report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest