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Indian Pediatr 2017;54: 246-247 |
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Profile of Children
Hospitalized with Acute Poisoning in New Delhi
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*Manas Pratim Roy, Ratan Gupta, Meenakshi Bhatt and
Kailash Chander Aggarwal
Department of Pediatrics, VMMC and Safdarjung Hospital,
New Delhi, India.
Email: * [email protected]
Published online: February 02, 2017.
PII:S097475591600045
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195 cases of acute poisoning among
children (age<12 y) in a tertiary hospital were identified over a period
of one year. Two-thirds (63%) of them were males and 75% were below five
years of age. Poisoning by medicines was most common (17%) followed by
ingestion of corrosives/detergents (16%) and kerosene (14%).
Keywords: Corrosive ingestion, Drug overdose,
Toxicology.
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Acute poisoning in children is commonly accidental
in nature, with preventable morbidity and mortality. In the year 2004,
more than 45,000 deaths of people under 20 years of age occurred due to
poisoning. South-East Asia documented 1.7 fatal child poisoning cases
per 100,000 population [1]. Such cases constitute 1-2% of total
pediatric admissions in our country [2,3].
We analyzed hospital database for one year – from
February 2015 to January 2016 with an objective to study the profile of
acute poisoning in children (age <12 years) admitted in a tertiary
hospital in New Delhi. Permission for conducting the study was taken
from Institutional Ethical Committee. Telephonic consultation was sought
from National Poisons Information Centre (NPIC), AIIMS whenever
required.
During the study period, 195 children (123 boys) were
hospitalized with a history of poisoning; 146 were below five years of
age. Most common form of poisoning was due to ingestion of medicine (n=34,
17%). Thyroxine was the most common medicine (21%) consumed, followed by
phenytoin (n=7, 15%) and benzodiazepines (n=5, 12%). Other
agents of poisoning are listed given in Table I. About 79%
(n=154) of the children with poisoning were discharged and 19%
children (n=37) left the hospital without any intimation. Death
occurred in four (2%) cases (n=4) – mostly due to the ingestion
of unknown substance. All the children who died were below five years of
age.
TABLE I Agents Implicated in Childhood Poisoning in Present Study (n= 195)
Agents in childhood poisoning |
Number (%) |
Drugs |
34 (17) |
Detergent/Corrosive/Surf/Soap water |
31 (16) |
Kerosene |
27 (14) |
House cleaner |
24 (12) |
Pyrethroids/mosquito repellents |
19 (10) |
Pesticides/Rat killer |
14 (7) |
Unknown |
11 (6) |
Others* |
35 (18) |
*Diesel (n=7), Thinner (n=5), Mercury (n=3), Camphor (n=3),
Disinfectant (chloroxylenol + terpeniol; n= 3), organophosphorus
(n= 2), petrol (n=2), acetone (n=2), sulfas (n=1), turpentine
(n=1), datura (n=1), fire cracker (n=1), soda (n=1), rock salt
(n=1), household mosquito repellent cream (n=1), lizard in milk
(n=1). |
The mortality rate in our set up was much lower than
previous reports from India [4,5].
However, the rate of leaving the hospital without
intimation was higher. This might be due to fear of legal repercussions
in such cases. Higher proportion cases among younger age group, as seen
in our study, has been reported earlier [2,4,6]. Young children—due to
their curious nature, close position to the floor and tendency to put
things in their mouths—are often victims of accidental poisoning [6].
Drugs and kerosene, similar to our observations, were the most common
agents leading to hospital admission for pediatric poisoning in other
studies [4,6]. American Academy of Pediatrics also identified medicines,
cleaning agents and kerosene among common agents implicated in such
accidents [7]. Storage of kerosene/ petrol/ diesel in empty bottles of
soft drinks within reach of children is often a cause of such poisoning.
For preventing poisoning with medicines, previous
studies emphasized on keeping them out of reach of the children [2,6].
WHO has earlier stressed on laws mandating child-proof packaging of
medicines [1]. More importantly, there is gradual rise in the number of
medications present in any household at any given point of time, making
toddlers vulnerable [8]. Availability of thyroxine, which is a commonly
used drug by adults, in a container probably makes it easier to consume
than any other drugs packed in blister packaging or supplied with
child-resistant packages.
We conclude that ingestion of medicine and household
products remain important causes for acute poisoning in children.
Careful storage of common household products implicated in pediatric
poisoning and keeping medicines in child-proof containers or under lock
and key may reduce such poisoning to a great extent.
Contribution: MPR, RG, KCA: conceived the study;
RG,MB: collected data; MPR, RG, MB: literature review. Manuscript was
written and finalized by all the authors.
Funding: None; Competing interest: None
stated.
References
1. WHO, UNICEF. World Report on Child Injury
Prevention. World Health Organization. Geneva. 2008. p. 123-42.
2. Bhat NK, Dhar M, Ahmad S, Chandar V. Profile of
poisoning in children and adolescents at a north Indian tertiary care
centre. J Indian Acad Clin Med. 2012;13:37-42.
3. Gangal R, Haroon A. Profile of acute poisoning in
pediatric age in district Moradabd: A hospital based study. J Indian
Acad Forensic Med. 2015;37:155-9.
4. Vasanthan M, James S, Shuba S, Abhinayaa J,
Sivaprakasam E. Clinical profile and outcome of poisoning in children
admitted to a tertiary referral center in South India. Indian J Child
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poisoning in children: seven year experience at a tertiary care hospital
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7. American Academy of Pediatrics. Poison Prevention
and Treatment Tips: National Poison Prevention Week. March 20-26, 2016.
Available from:
https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/poison-prevention-and-treatment-tips-.aspx?nfstatus=401&nftoken=00000000-0000-0000-000
0-000000000000&nfstatusdescription=ERROR:+No+ local+token. Accessed
August 16, 2016.
8. Budnitz DS, Lovegrove MC. The last mile: taking the final steps in
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