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Targeting 100% survival in toxicology cases
Dr pramod sarwa
Introduction Poison is a substance that causes damage or injury to the body and endangers one’s life due to its exposure by means
ofingestion, inhalation or contact (Thomas et al., 2004).
Acute poisoning is defined as acute exposure (less than 24hrs) to the toxic substance (Klassen et al., 1986).
Acute poisoning due to Accidental and suicidal exposure causes significant mortality and morbidity throughout the world According to the World Health Organization (WHO), 99 per cent of the fatal poisoning cases occur in developing countries, predominantly among the farmers due to various kinds of poisoning, including poisonous toxins from natural products during handling
Cont.. According to World Health Organization
(WHO), globally more than three million of acute poisoning cases with 2, 20,000 deaths occur annually (WHO1999).
It has been estimated that, in India five to six persons per lakh of population die due to acute poisoning every year (Narayana Reddy, 2010).
Poisoning is the fourth common cause of mortality in India (Unikrishnan et al., 2005)
Cont. According to various studies
organophosphate forms the commonest poisoning agent
(Adalkha et al., 1988; Jaiprakash et al., 2011; Jesslin et al., 2010; Vinay et al.,2008; Ramesha et al.,
2009).
Mortality in op 18to20% (indian J Anaesth. 2014 Jan-Feb; 58(1): 11–17.Survival pattern in patients with acute organophosphate poisoning on
mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital. ………..Syed m ahmed,bikramjit das, abu nadeem and rajiv k samal.)
Number of toxicology cases 74prospective study period = feb 13 to nov 14
unknown; 6; 8%
op; 19; 26%
celphose; 18; 24%
snake bite; 15; 20%
rat poison; 4; 5%
acid; 2; 3%
scorpion/bee/an-imal; 3; 4%
kerosene; 1; 1%miscell; 6; 8% poisoning cases
Sex distribution
unkno
wn op
celph
ose
snake
bite
rat po
ison
acid
scorpi
on/be
e/anim
al
kerose
ne
miscell
0123456789
10
4
10
89
2
01
0
42
89
6
2 2 2
12
malefemale
Ventilator required
2
8
7
111
2 1
6
19
18
15
42
3 1 6 unknownopcelphosesnake biterat poisonacidscorpion/bee/an-imalkerosenemiscell
HD/CRRT required
1
11
1
6
19
18
15
42
3 16
unknown
op
celphose
snake bite
rat poison
acid
scorpion/bee/an-imal
kerosene
miscell
icu stay
unkno
wn op
celph
ose
snake
bite
rat po
ison
acid
scorpi
on/be
e/anim
al
kerose
nemisc
ell0123456
avg icu stay in days
avg stay in days
Toxicology cases survival at JRCCTH
0
2
4
6
8
10
12
14
16
18
6
1817
15
4
23
1
6
3
18
8
15
4
21 1
6
number of casessurvived
Survival in toxicology cases at jrccth
OP……..100% Snake bite…100% Celphos…50% Acid ingestion..100% Rat poison ..100% Kerosene ..100% Unknown poison..50% Miscellaneous 100% (phenol,terpentine,
alcohol, neem, dhaturaNitrobenzene )
Year 2013 … 22 out 27
0
1
2
3
4
5
6
7
8
5
8
6
12
3
0
22
8
6
12
10
2
2013survival in 13
Year 2014…. 29 out 29
unkno
wn op
snake
bite
rat po
ison
acid
scorpi
on/be
e/anim
al
kerose
ne mis0
2
4
6
8
10
12
1
11
9
3
0 01
4
1
11
9
3
0 01
4
2014surival in14
celphos Bajwa SJ, Bajwa Kaur SK, Kaur J, Singh K, Panda A.
Management of celphos poisoning : A ray of hope in the
darkest of clouds. Anesth Essays Res 2010;4:20-4 survival rate 42% .
This poisoning has a high mortality (40–100%) and survival is unlikely if more than 1.5 g is ingested. the lethal dose is 150–500 mg for an adult Proudfoot AT. Aluminium and zinc phosphide poisoning. Clin Toxicol (Phila) 2009;47:89–100. [PubMed
Celphose .. Old protocall
number of cases crrt/hd survived survived with RRT survived without RRT
0
2
4
6
8
10
12 11
5
3
1 1
before july14
before july14
Celphose ..new protocall
number of cases crrt/hd survived survived with RRT survived without RRT
0
1
2
3
4
5
6
7
76 6 6
0
after july 14
after july 14
Celphose cases survial
number crrt/hd survived survived with RRT
survived without RRT
0
2
4
6
8
10
1211
5
3
1 1
6
5 5 5
0
before july14after july 14
After july 2014.. 85.71%
cases
Targeting 100% survival in poisoning casescelphose
very aggressive management of metabolic acidosis
early institution of HD/CRRT/SLED massive bicarbonate therapy
Targeting 100% survival in poisoning cases op poisoning
Apart from decontamination , supportive treatment ,important role of
Early PCT Early mechanical ventilation PAM in non carbamate poisoning
Targeting 100% survival in poisoning cases Snake bite
ASV Early identification and management
of complication like intracranial hemorrhage coagulopathy muscle weakness necrosis
conclusion
Early identification Definitive care Early aggressive management Recognition of complications Management of complication Documentation