International

Journal of Pharmacy Teaching & Practices 2015, Vol.6, Issue 4, 2615-.2619

Introduction to Poisoning; A Systematic Review


Sumbria Tarlok*, Sharma Amit 1
, Prabhakar Shina 1
, Kosey, Sourabh1, Devgan Shalini2

1- Department of Pharmacy Practice, I. S. F. College of Pharmacy, Moga, Punjab, India

2- Department of Surgery-II, Guru Gobind Singh Medical College Hospital & Research Centre,

Faridkot, Punjab, India.



Review Article cause illness or injury. Some poisons cause

1
Please cite this paper as Sumbria Tarlok*, Sharma Amit ,
immediate injury, such as battery acid or
1 1 2
Prabhakar Shina , Kosey, Sourabh , Devgan Shalini . household cleaners. Other poisons may take years
Introduction to Poisoning; A Systematic Review. IJPTP, of exposure to create a health problem, such as
2015, 6(4) , 2615-2619.

heavy metals (lead, arsenic, mercury). The Centers
Corresponding Author: for Disease Control and Prevention (CDC) defines a


Mr. Sourabh Kosey, poisoning that occurs by accident as "unintentional

Associate Professor, poisoning" and a poisoning that results from a

Department of Pharmacy Practice, conscious, will full decision (such as suicide or
I.S.F. College of Pharmacy, Moga, Punjab, India

E-mail: [email protected]

homicide) as "intentional poisoning" Unintentional
poisoning includes the use of drugs or chemicals
for recreational purposes in excessive amounts,

Introduction such as an overdose. Unintentional poisoning also
Poison includes the excessive use of drugs or chemicals for
The term poison was derived from Latin non-recreational purposes, such as by an infant or
word “potionem” a drink; i.e.,drink, eat, child. Intentional poisonings include suicide, such
breathe, inject or touch enough of a as medication over dosage (B.R. Sharma et al.,
chemical (also called a poison or toxin) to 2007). Young children are particularly vulnerable to
cause illness or death or poison is derived accidental poisoning in the home, as are elderly
from Greek word ‘Toxicon’ which means people, often from confusion. Hospitalized people
‘Poison’. A poison is any substance that is and industrial workers are also vulnerable to
harmful to the body when eaten, breathed, accidental poisoning by drugs errors and from
injected or absorbed through the skin. Any exposure to toxic chemicals, respectively (Tanuj
substance can be poisonous if enough is kanchan et al., 2008). The damage caused by
taken. poisoning depends on the poison, the amount
Poisoning taken and the age and underlying health of the
Poisoning is an important health problem in person who takes it. Some poisons are not very
every country of the world. Occupational potent and cause problems only with prolonged
exposure to industrial chemicals and exposure or repeated ingestion of large amounts.
pesticides, accidental or intentional Other poisons are so potent that just a drop on the
exposure to household to pharmaceutical skin can cause severe damage.
products and poisoning due to venomous Categories of Poisoning
animals, toxic plants and food Poisoning is divided in to 4 broad categories:-
contamination, all contribute to morbidity Pharmaceuticals: Paracetamol, Aspirin,
and mortality (Lall S.B et al., 2003). The Benzodiazepines, Phenytoin, Tricyclic
danger of poisoning range from short-term Antidepressants, Barbiturates, Opioids etc.
illness to brain damage, coma and death.
Some poisons in very small amounts can

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Insecticides and pesticides: increased substantially in the past decade and this
Organophasphate, Chlorine, Pyrethroids, country is the largest market for pesticides for sub
Superwarfarin, Furadon, Parathion And Saharan Africa (Leslie London and Ross Bailie
Endosulphan. 2001).
Plants and Animals: Snake or Scorpian bite,
Bees or Wasps sting, Insect sting, Oleander,
Dhatura and Oduvanthalai.
Chemicals:
• Inorganic: Mercury, arsenic, lead, copper,
Sulfur and Hair Dye (Paraphenylenediamine).
Figure 1.2: Insecticides and Pesticides
• Organic: Rotenone, Pyrethrum, Nicotine
and Neem Oil. Organophosphate Poisoning
• Biological: Bacteria and viruses (Salmonella, It is one of the commonest poisons consumed, as it
Norovirus, Norwalk Virus, Campylobacter, E. is easily available. Among the organophosphorous
coli, Listeria, Clostridium perfringens). compound, methyl parathion (metacid) is the most
Most of victims of travel related poisoning commonly used the other compound is
were businessman (67.56%) rest were Dichlorovos (nuvan) (Bhattarai MD et al., 2006).
normal and domestic travelers (16.21%) and Organophosphorus poisoning occurs very
few were service holder (10.81%) (Howlader commonly in southern India, where farmers form a
Mar et al., 2008). Some other victims take significant proportion of the population who
poisonous material easily available in the commonly use Organophsphorus compound like
household or at work place like rat killer Parathion as Insecticides. Thus, due to the easy
(superwarfarin), mosquito repellant accessibility of these compounds, a large number
(pyrethroid) ant killer (gamma hexene), of suicidal cases are encountered in this region
organo compounds (furadon, parathion, (Subhash Vijay Kumar et al., 2011).
endosulphan). They also takes drugs which
are available at house (either taken by them
or house members) like alprazolam,
diazepam, phenytoin, barbiturates,
paracetamol, aspirin etc. since all the drugs
are easily available over the counter, we also Figure 1.3: OPC Poisoning Substances
see lot of multidrug over dosage especially
combination of antibiotics, analgesics and Most toxic compounds are Endosulphan, methyl
antihistamines. parathion, malathion, oleander seeds (in higher
doses), Dhatura, Zinc sulphide and Phosphide. Less
toxic compounds are Gammahexene, Pyrethroids
and Superwarfarin.


Figure 1.1: Multiple tablets (Overdose)

Pesticide poisoning
It is a major public health problem in Figure 1.4: Oleander Seed and Dhatura Fruit
developing countries particularly in setting in Snakes
low education and poor regulatory These are found all over the world except in the
framework. Pesticide usage in South Africa, arctic, New Zealand and Ireland and are more
both agricultural and non agricultural has commonly distributed in temperature and tropical

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countries. Snakes are most likely to bite people die each year from snake bite which is a
human beings when they feel threatened, common cause of morbidity and mortality in India
startled or provoked and have no means of (Subhash Vijay Kumar et al. 2011). Snake bite is a
escape cornered. The Deccan plateau, with large problem of the rural area, where basic health
its agricultural land and hot, dry climate facilities are poor and as a result death is common.
provides an ideal environment for cobras, The four families of venomous snake’s
kraits and vipers (Inamdar et al., 2010). atractaspididae, elapidae, hydrophidae and
viperdae contain some 500 species; whereas the
fifth family, the colubridae contain 40 species
venomous to humans. Less than 200 species have
caused clinically severe envenoming, ending in
Figure 1.5: Snake poison
death or permanent disability (Atta Muhammad
The most common symptoms of all
chandio, 2000). There are some 300 species of land
snakebites are overwhelming fear, which
snakes in Pakistan out of which 40 are poisonous.
may cause symptoms such
The commonest poisonous snake in Pakistan is
as nausea and vomiting, diarrhea, vertigo,
cobra, viper and krait (Atta Muhammad chandio,
fainting, tachycardia and cold, clammy skin.
2000).
Dry snakebites and those inflicted by a non-
venomous species, can still cause severe
injury. There are several reasons for this
snake bite area may become infected with
the snake's saliva and fangs sometimes
harboring pathogenic microbial organisms, Figure 1.6: Snake bite
including Clostridium tetani. Infection is
often reported with viper bites whose fangs Food poisoning
are capable of deep puncture wounds. Bites It is defined as an illness caused by the
may cause anaphylaxis in certain people. consumption of food or water contaminated with
Most snakes bites, whether by a venomous bacteria and their toxins or with parasites, viruses
snake or not, will have some type of local or chemicals. The most common pathogens are
effect. There is minor pain and redness in Norovirus, Escherichiacoli, Salmonella, Clostridium
over 90 percent of cases, although this varies perfringens, Campylobacter and Staphylococcus
depending on the site. Bites by vipers and aureus.
some cobras may be extremely painful, with
the local tissue sometimes becoming tender
and severely swollen within five minutes.
This area may also bleed and blister and can
eventually lead to tissue necrosis. Other
common initial symptoms of pit
viper and viper bites include lethargy, Figure 1.7: Food poisoning
bleeding, weakness, nausea and vomiting. Hair dye poisoning
Symptoms may become more life- It is an emerging as one of the important causes of
threatening over time, developing intentional self-harm in the developing world. Hair
into hypotension, tachypnea, severe dyes contain paraphenylenediamine and a host of
tachycardia, severe internal bleeding, altered other chemicals that can cause rhabdomyolysis,
sensorium, kidney failure and respiratory laryngeal edema, severe metabolic acidosis and
failure. Snakebite is a common acute medical acute renal failure (J Emerg Trauma Shock. 2009
emergency faced by rural population in May-Aug). Hair dye and its constituent
tropical and subtropical countries with heavy paraphenylenediamine (PPD) have been reported
rainfall and humid climate. 35,000-50,000 as accidental and intentional causes of poisoning
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from developing countries in Africa and Asia. or drink while using art products. Wash skin after
Ingestion of Super-Vasmol33 (Trade Mark), a contact with art products. Clean equipment; wipe
common, inexpensive, emulsion based hair tables, desks and counters.
dye has been increasingly used for deliberate Kitchen: Wash hands and counters before
self-harm in India. The constituents of this preparing all food. Store food at the proper
dye are PPD, resorcinol, propylene glycol, temperatures. Refrigerated foods should not be
ethylene-diamine-tetraacetic acid (EDTA) left out at temperatures above 400 F (50C). Use
sodium, liquid paraffin, cetostearyl alcohol, clean utensils for cooking and serving.
phenol, sodium lauryl sulphate, herbal Outdoors: Know what poisonous snakes live in
extracts, preservatives and perfumes. The your area and wear proper attire (boots etc.) when
combined effect of the individual toxicants hiking outdoors. Check the label on any insect
results in significant morbidity and mortality repellent, most contains N-Diethyl meta Toluamide
(Augrah Chrispal et al., 2010). or Diethyltolumide (DEET), which can be poisonous
in large quantities. Be sure that everyone in your
family can identify poisonous mushrooms and
plants. (U.S. Department of Health and Human
Services).
The causes and type of poisoning vary in different
parts of the world depending upon the factors such
Figure 1.8: Hair Dye Poisoning as demography, socioeconomics, status, education,
local belief and customs. Many-civilian and
Common Causes of Poisoning industrial, accidental and deliberate (Budhathoki et
• Pain killers al. 2009). The problem is getting worse with time
• Cosmetics or personal products as newer drugs and chemicals are developed in
• Household cleaning products vast numbers. Today there are more than 9 million
• Sedatives, hypnotics and antipsychotics natural and synthetic chemicals, and the list keeps
medicine growing inexorably. However, less than 3000 of
• Foreign bodies, toys and other objects these cause more than 95% of the reported cases
of poisoning. Some drugs causes poisoning were
How to Poison Proof Your Home classified in one of eight categories as follows:
Medicines: Keep medicines in their original medical drugs, corrosives, alcohol,
containers, properly labeled and store them organophosphate, insecticides, rat poison
appropriately. (superwarfarin), carbon monoxide (CO) and
Carbon Monoxide (CO) Detector: Have a mushroom. The medical drugs were categorized in
working carbon monoxide detector in your to eight subgroups as psychoactive drugs,
home. The best places for a CO detector are analgesics, antibiotics, cardiovascular drugs,
near bedrooms and close to furnaces. antiemetic, multiple drugs, others (hormones,
Household Products: Keep products in their vitamins, minerals, antidiabetics, anticholinergics
original containers. Do not use food and antihistamincs) or unknown (Ferruhniyazi et
containers like cups or bottles to store al., 2009).
antifreeze, household cleaners or other
chemicals or products. Mechanism of Toxicity
Arts and Crafts: Some art products are There are several specific acting modes of toxic
mixtures of chemicals which should be kept action:
in their original containers. They can be Uncouplers of oxidative phosphorylation: Involves
dangerous if not used correctly. Make toxicants that uncouple the two processes that
sure children use art products safely by occur in oxidative phosphorylation i.e. electron
reading and following directions. Do not eat

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transfer and adenosine triphosphate (ATP) general, parathion compounds are not significant
production. inhibitors in their original form and need metabolic
Acetyl-cholinesterase (AChE) inhibitors: activation (oxidation) in vivo to oxon form. For
AChE is an enzyme associated with nerve example, parathion has to be metabolized to
synapses that is designed to regulate nerve paraxon in the body so as to actively inhibit AChE.
impulses by breaking down the The toxic mechanism of OP pesticides differs from
neurotransmitter Acetylcholine (ACh).When that of carbamates which inhibit the same enzyme
toxicants bind to AChE, they inhibit the reversibly and are sometimes useful as medicines
breakdown of ACh. This results in continued (neostigmine, pyridostigmine) as well as
nerve impulses across the synapses, which insecticides (carbaryl). After the initial inhibition
eventually cause nerve system damage. and formation of Acetylcholine esterase
Examples of AChE inhibitors organophosphate (AChE-OP) complex two further
are organophosphates and carbamates, reactions are possible: Spontaneous reactivation of
which are components found in pesticides. the enzyme may occur at a slow pace, much slower
Irritants: These are the chemicals that cause than the enzyme inhibition and requiring hours to
an inflammatory effect on living tissue by days to occur. The rate of this regenerative process
chemical action at the site of contact. The solely depends on the type of OP compound. In
resulting effect of irritants is an increase in general, AChE dimethyl OP complex spontaneously
the volume of cells due to a change in size reactivate in less than one day whereas AChE
(hypertrophy) or an increase in the number diethyl OP complex may take several days and re-
of cells (hyperplasia). Examples of irritants inhibition of the newly activated enzyme can occur
are benzaldehyde, acrolein, zinc significantly in such situation. The spontaneous
sulphate and chlorine. reactivation can be hastened by adding
Central nervous system (CNS) seizure nucleophilic reagents like oximes, liberating more
agents: CNS seizure agents inhibit cellular active enzymes. These agents thereby act as an
signaling by acting as receptor antagonists. antidote in organophophate poisoning. With time
They result in the inhibition of biological the enzyme-OP complex loses one alkyl group
responses. Examples of CNS seizure agents making it no longer responsive to reactivating
are organochlorine pesticides. agents. This progressive time dependent process is
Respiratory blockers: These are toxicants known as ageing. The rate of ageing depends on
that affect respiration by interfering with various factors like pH, temperature and type of OP
the electron transport chain in the compounds dimethyl OPs have ageing half-life of
mitochondria. Examples of respiratory 3.7 hours whereas it is 33 hours for diethyl OPs.
blockers are rotenone and cyanide. The slower the spontaneous reactivation greater
the quantity of inactive AChE available for ageing.
Mechanism of Organophosphates Oximes by catalyzing the regeneration of active
These compounds are based on the AChE from enzyme-OP complex reduce the
irreversible inhibition of acetylcholinesterase quantity of inactive AChE available for ageing.
(AChE) due to phosphorylation of the active Since ageing occurs more rapidly with dimethyl
site of the enzyme. This leads to OPs, oximes are hypothetically useful before 12
accumulation of acetylcholine and hours in such poisoning. However, in diethyl OP
subsequent over activation of cholinergic intoxication they may be useful for many days.
receptors at the neuromuscular junctions A mode of toxic action is a common set
and in the autonomic and central nervous of physiological and behavioral signs that
systems. The rate and degree of AChE characterize a type of adverse biological
inhibition differs according to the structure response. A mode of action should not be confused
of the Organophosphate (OP) compounds with mechanism of action, which refers to
and the nature of their metabolite. In the biochemical processes underlying a given mode

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of action. Modes of toxic action are • Specific drug levels (as discussed below) may be
important, widely used tools helpful in confirming the diagnosis and in making
pollutants in eco-toxicology and aquatic management Decisions (Guideline of Investigation
toxicology because they classify toxicants or of the poisoned patient, 2006).
according to their type of toxic action. There
are two major types of modes of toxic Diagnostic Tests
action: non-specific acting toxicants and • Laboratory evaluation is indicated in the following
specific acting toxicants. Non-specific acting cases:
toxicants are those that produce narcosis, • Any intentional ingestion
while specific acting toxicants are those that • When the ingested substance is unknown
are non-narcotic and these produces a • When the toxin has the potential to produce
specific action at a specific target site moderate to severe toxicity
(Poadyal BP, 2008). • The patient has more than minimal symptoms

Physical Examination Additional Tests for an Intentional Overdose
• A physical examination usually includes: Include the Following:
• Inspection (looking at the body)
• Palpation (feeling the body with fingers or • An electrocardiogram as a screen for poisoning
hands) with tricyclic antidepressants or other cardiotoxic
• Auscultation (listening to sounds) agents (Tricyclics antidepressants cause widened
• Percussion (producing sounds, usually by QRS intervals and tachycardia).
tapping on specific areas of the body) • Chest radiographs are useful to detect pulmonary
• A complete physical examination should be damage in patients with suspected aspiration, non-
performed to detect complications and to cardiogenic pulmonary edema or other lung injury.
help with the diagnosis. • Abdominal radiographs are useful screening tools
• Specific attention should be paid to vital in patients who may have ingested radio opaque
signs, mental status (depressed or agitated), material such as lithium, iron, lead and other heavy
respirations (depressed, evidence of metals. Drug packets and enteric coated
pulmonary edema or aspiration), pupils (size, compounds may also be detectable on plain films
reactivity, presence of nystagmus), skin (Guideline of Investigation of the poisoned patient,
(diaphoresis or abnormally dry, blisters), 2006).
bowel sounds (increased or decreased).
Based on findings from physical examination,
the clinician should specifically consider the General management of poisoning
presence of a Toxidrome (Guideline of
Investigation of the poisoned patient, 2006). The general management of these cases is
anticipatory and supportive and the importance of
Diagnosis assessing airway, breathing and circulation cannot
Consideration of poisoning in patients with be over emphasized. If the airway can be
altered consciousness or unexplained protected, activated charcoal may be indicated to
symptoms decrease absorption if the patient presents within
• History from all available sources 1 hour of ingestion. Whole bowel irrigation is rarely
• Selective, directed testing performed and occasionally endoscopic retrieval
• Identification of the toxin involved is based may be indicated for body stuffers. Urgent surgery
on history, physical examination and may be required for body packers or stuffers and
clinical course as well as selected diagnostic these cases should be discussed with surgeons
tests. early.

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For any patients admitted with poisoning syndromes based on their Pharmacological
first their vitals has to be stabilized like properties. Common complications of poisoning
protecting the include depressed mental status, Coma and altered
• Airway (oropahryngeal or nasopharyngeal conscious state, seizures, delirium and agitation,
airway) hypotension, bradycardia and vomiting. Most of
• Breathing (nasal prong or face mask with these can be treated empirically without
venture or intubation and mechanical knowl¬edge of the toxin involved and without
ventilation) specific antidotes. Management of these
• Circulation (inotropes) complications occurs with history, physical
Any acute problem has to be treated like examination and specific laboratory tests
giving antiepileptic medication for patients (Guideline of Investigation of the poisoned patient,
with seizures in endosulphan poisoning. All 2006).
patients should be given gastric lavage
(except for corrosive poisoning with Antidotes
sulphuric acid, kerosene, paraffin and An antidote is a substance which can counteract a
diesel). All patients irrespective of the time form of poisoning. The term ultimately derives
of intake of poison should be given activated from the Greek “antididonai” i.e. "given against".
charcoal for prevention of absorption of the The antidotes for some particular toxins are
drug and magnesium sulphate for increasing manufactured by injecting the toxin into an animal
the motility and fastening the excretion. in small doses and extracting the
Treatment goals resulting antibodies from the host animal’s blood.
The basic goals for treatment of acute This results in an antivenom that can be used to
poisoning assess patient condition, counteract poison produced by certain species
symptoms and prognosis to study treatment of snakes, spiders and other venomous animals. A
pattern of poisoning. Assist an improvement number of venoms lack available antivenom and a
in drug therapy and better patient care to bite or sting from an animal producing such a toxin
analyze the patients admitted due to the often results in death. Some animal venoms,
poison with respect the socio-demographic especially those produced by arthropods (e.g.
profile, etiological agents used clinical certain spiders, scorpions, bees, etc.) are only
aspects and outcome. The treatment of potentially lethal when they provoke allergic
acute poisoning can be summarized in four reactions and induce anaphylactic shock; as such,
points: life support, which involves common there is no "antidote" for these venoms because it
measures to treat any urgent and serious is not a form of poisoning and anaphylactic shock
pathology, reducing absorption of toxin, can be treated (e.g., by the use of epinephrine).
increasing its elimination and the use of
specific antidotes (Raquel Aguilar Salmeron Some other toxins have no known antidote. For
et al., 2009). example, the poison Aconitine a highly poisonous
alkaloid derived from various aconite species has
Managing Common Complications no antidote and as a result is often fatal if it enters
Complications of poisoning are relevant to the human body in sufficient quantities. The use of
clinical toxicologists for two reasons: antidotes may reduce the use of other medical
Organ toxicity affecting major organs such as resources needed for the treatment of poisoning,
the heart, respiratory tract, kidneys and liver shorten hospital stay and even save of life.
present problems in assessment and However, these drugs are not without side effects
management on a regular basis in poisoned and in some cases, their economic cost is high. It is
patients. therefore necessary to evaluate the benefit and
Complications of poisoning may assist the risk involved in the administration of antidotes.
clinician as poisons may produce specific

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Table 1.1 List of antidotes • Glucose must be given immediately in
S. NAME ANTIDOTE hypoglycemia.
NO • Prompt administration of naloxone may avoid the
1 Acetaminophen N-Acetylcystein
need for endotracheal intubation in opiate
2 Anticholinergics agent Physostigma
3 Benzodiazepine Flumazenil
overdose.
4 Carbom monoxide Oxygen, hyperbaric • Pyridoxine should be given as soon as possible for
oxygen seizures associated with isoniazid overdose
5 Cyanamide Amyl Nitrate, Sodium (Guideline of Investigation of the poisoned patient,
Nitrate, 2006).
SodiumThiosulfate,
Hydroxycobalamin.
An antidote is a chemical that will counteract the
6 Digitalis Digoxin immune feb effects of a poison. If administered soon enough
7 Methanol Ethylene Femepizol and in sufficient quantities, an antidote can save
glycol the life of a human or animal that has been
8 Heparin Protamin sulfate poisoned. Antivenom or antivenin is a kind of
9 Lead Dimercapto-succinic antidote for the venom resulting from the bite or
acid
10 Mercury arsenic gold Dimercaprol
sting of a poisonous creature. While many poisons
11 Methemoglobinemia Methylene blue have a known antidote, some are expensive and
12 Opiates Naloxone, nalmefene difficult to produce. If someone is known or
or naltrexone suspected to have been poisoned, a poison control
13 Organophosphomates, Atropine, center will be able to determine the best course of
carbamates, pralidoxime
action.
cholinergics
14 Ethanol Drip, Dialysis

Experimental trials Most poisons and venoms are spread rapidly
Toxic Alcohols
underway on Enzyme through the body by the bloodstream, so prompt
Inhibitors. medical attention is essential for the effectiveness
15 Tricyclic of an antidote. Activated charcoal is used as the
Sodium Bicarbonate
Antidepressants
antidote for a wide range of poisoning cases.
16 Barbiturates Activated charcoal
17 Phenothaizine Benztropine, Ingested by the patient, it absorbs some poisons
procyclidine and prevents them from passing into the blood
18 Kerosene Oxygen, antibiotics, stream. Ethanol, insulin and sodium bicarbonate or
steroids baking soda is other well-known substances that
19 Oleander seeds Atropine,dopamine,e serve as antidotes for some poisons.
pinephrine,isoprenali
ne
Table 1.2 Newer Antidotes
20 Isoniazid Pyridoxine (vitamin Sr. POISON ANTIDOTES
B6)
21 Radioactive iodine Potassium iodide No.

22 Snake, coral Micrurusfulvius 1 Cardiac glycoside Fab antibodies

antivenin
2 Sympathomimetic Esmolol
23 Snakes (rattlesnakes, Crotalidae polyvalent
cotton-mouth, antivenin drugs hydrochloride
copperhead) Crotalidae polyvalent
3 Hypoglycemic agent Octreotide
immune fab
24 Thallium Prussian blue (sulphonylurea)
4 Arcenic, lead, mercury Succimer

5 Methanol, ethylene Fomepizole (4-
• Antidotes are typically given after the
patient has been stabilized and the diagnosis glycol methylpyrazole)
has been made. In certain cases, prompt 6 Cyanide Hydroxycobalamine
administration of antidote is imperative.
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Oman. La revue de santé de la mediterranee Orientale
Unfortunately, antivenoms are costly to 2003; 9(6); 944-954.
produce and demand is low. The economics 2. B.R. Sharma, Nidhi relhan, Neha gupta and
of the Pharmaceutical industry mean they Harshabad singh. Trends of fatal poisoning in northern
India, a ten-year autopsy Analysis. A Journal of
are often not available in impoverished
pharmacology and toxicology, 2007; 2 (4): 350-358.
countries. Scientists have had some success
3. Tanuj kanchan, Ritesh G. Mnezes, diplomate NB.
in creating universal antivenoms by studying Suicidal poisoning in southern India: gender differences.
the DNA of venomous creatures. It is also Journal of forensic and legal Medicine 2008; 15(7)10-18.
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other poisons by regularly ingesting small improving surveillance for pesticide poisoning; policy
quantities of the poison. This process is implications for developing countries. International
called mithridatism. (Raquel Aguilar journal of epidemiology 2001; 3(2) 564-570.
Salmeron et al. 2009). 5. Subhash Vijay Kumar, B. Venkateswarlu, M.Sasikala,
G.Vijaykumar. A study on poisoning cases in a tertiary
Conclusion care hospital. Journal of natural science, biology and
science 2010; 1(2) 35-39.
Acute poisoning is a common and urgent
6. Inamdar I F, N R Aswar, M Ubaidulla, S D Delvi. Snake
medical problem in our country. The bite: admission at a tertiary health care centre in
mortality and morbidity due to poison can Maharashtra SAMJ 2010; 100(7) 450-456.
be reduced by the conducting educational 7. Atta Muhammad chandio, Perviaz Sandelo, Ali Akbar
programs, and various audio-visual Rahu, S. Tausif Ahmad, Amir Hamzo Dahro and Rashida
presentations like how to prevent the Bhatti. Snake bite treatment seeking behavior among
poisoning in rural areas and providing sindh rural population JAMC 2000;12(3): 1-5.
counselling services and poison information 8. Augrah Chrispal, Anisha Begum, Ramya, Anand
service to the people. People involved in Zachariah. Hair dye poisoning an emerging problem in
health care professional must be aware of the tropics: an experience from a tertiary care hospital
pattern of the common poisoning agents as in South India; Tropical Doctor 2010; 40: 100–103 DOI:
10.1258/td.2010. 090367
well as their emergency household
9. Z. singh & B.Unnikrishnan. A profile of acute
management. Young adults should be
poisoning at manglore (south India). Journal of clinical
educated about the hazards of chemical use, forensic medicine 2006;2(13)112-116.
establishing a counselling center in each 10.Ferruhniyazi Ayoglu, Hilal Ayoglu, Yesim
hospital. Tertiary care hospitals should Macitkaptan, Isil Ozkocak Turan. A retrospective
establish a poison information center (PIC), Analysis of cases with acute poisoning in zonguldak,
which should be networked with other Turkey. Turk ansetdergisi 2009; 37(4):240-248.
poison information center in India and to 11.Poadyal BP. Organophosphorus poisoning,
developed countries which can help in department of medicine, patan hospital, lalitpur. J
identifying the poison and managing the Nepal Med Assoc. 2008; 47 (2):251-8.
cases and providing information to the 12.Guideline of Investigation of the poisoned patient,
toward optimized practice, administered by the Albarta
public regarding poison prevention.

Medical Association updates 2006; 9(2)17-18.
13.Raquel Aguilar Salmeron, Dolors Roy Muner,
Acknowledgement Santiago NougueXarau. Use and cost of antidotes in 2
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38. A Sharma, V Pandit. Importance of poison

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909.

AUTHORS’ CONTRIBUTIONS

Authors contributed equally to all aspects of the

study.

PEER REVIEW

Not commissioned; externally peer reviewed.

CONFLICTS OF INTEREST

The authors declare that they have no competing

interests.

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