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Year : 2014 | Volume : 2 | Issue : 1 | Page : 23 - 27  


Original Articles
A Study of Profile of Patients with Organophosphorus Compound Poisoning at a Teaching Hospital

Vinod Govsavi1, Vinayak E. Shegokar2, Sandeep M. Bhelkar3, Sudhir Tungikar4

1Consultant Physician, Max Superspeciality Hospital, Ulka Nagari, Aurangabad (Maharashtra), 2Professor of Medicine Chirayu Medical College & Hospital, Bhopal, Madhya Pradesh,

3Assistant Professor of Community Medicine, Govt. Medical College, Nagpur

4Associate Professor of Medicine, Govt. Medical College, Aurangabad  

Abstract:

Background: Organophosphorus compound poisoning forms an important public health problem especially in developing countries and rural population. Apart from its agricultural benefit its increasing use in agriculture, the farmer’s and those involved in its manufacture are at increased risk.

Objectives: To study the incidence of Organophosphorus compound poisoning and to study the profile of patients admitted with Organophosphorus compound poisoning.

Methods: A hospital based cross sectional study was carried out from September 2002 to August 2003. A total of 200 patients were studied who were admitted to the hospital with Organophosphorus compound poisoning. Data was recorded in a pre designed questionnaire and proportions were used for analysis of the data.

Results: Maximum cases of Organophosphorus compound poisoning (41%) were in the 21 – 30 years of age group. Both among males and females, maximum cases were married. It is seen that as the level of literacy increased the incidence of Organophosphorus poisoning is decreasing. Ingestion is the most common route of poisoning as seen in 99% of patients. Maximum i.e. 29.50% of poisoning cases were due to family conflict followed by marital conflict/disharmony. Most common Organophosphorus compound used for poisoning purpose was Roger i.e. Dimethoate in 43.5%.

Conclusion: Thus we found that maximum cases were in the age group of 21 – 30 years, married group and among farmers and reported during June to October. Ingestion was the most common route of poisoning and family and marital conflicts were the most common reasons leading to poisoning. Among insecticides, Roger was the most common compound used for poisoning.

Key Words: Dimethoate, Novacron, Organophosphorus compound poisoning

Corresponding Author: Dr. Vinayak E. Shegokar Professor of Medicine, Chirayu Medical Collage & Hospital, Bairagarh, Bopal (MP). Email: drvshegokar@rediffmail.com

 

Introduction:

Since man has started agriculture, he has been troubled by insects. He has been using insecticides since ages. Organophosphates were introduced in 1854 as pesticides but their toxicity was not known till 1931. [1] In India, they were introduced in 1960’s and their toxicity was reported first in 1962. [2]

Acute poisoning is one of the important causes of morbidity and mortality worldwide. Organophosphorus compounds are commonly used insecticides and forms the most frequent cause of poisoning in agricultural communities in India. It has been estimated that around three million cases of acute pesticides poisoning occur each year with 2,20,000 deaths. Ninety five percent of fatal pesticide poisoning occurs in developing countries. [3] In India acute poisoning accounts for about two to three percent in general hospitals. [4]

Due to rapid development in the field of science and technology and vast growth in the industrial and agricultural sector, poisoning is spreading like a wildfire. A number of chemical substances, which are developed to save the agricultural products from rodents and pests so as to protect the human from starvation, are in fact themselves proving to be man-eaters. [5] Organophosphorus poisoning has assumed alarming cause of poisoning for suicidal purpose in India as well as all over world. The widespread use of these agents in agricultural purposes and in domestic as household insecticide has made it an easily available all purpose poison. And hence it is the commonest suicidal and accidental poison encountered in most poison treatment centre.

As this teaching hospital is situated among rural population, the problems of Organophosphorus compound poisoning are very common. Here patients are admitted with consumption of Organophosphorus compounds or mixture with organochloro and organocarbamates used by farmers. Hence the present study was directed towards such patients of having clinical features of Organophosphorus compounds.

Material and Methods

Study Design: Hospital based Cross Sectional study.

Settings: The present study was carried out in the Department of Medicine, Government Medical College and Shri Guru Gobind Singhji Memorial Hospital, Nanded.

Study period: September 2002 to August 2003.

Study Population: During the study period a total of 51,745 patients were admitted to the hospital. Out of this, 1,082 were total cases of poisoning admitted. Out of this 1,082 poisoning patients, 200 were cases of Organophosphorus compound poisoning. These 200 cases were included in the study.

Methodology: Initially, Institution Ethics Committee Approval was obtained for the conduct of the study. Informed consent was obtained from all the 200 patients. Data was recorded in a pre-designed and semi-structured questionnaire. Only those patients admitted with Organophosphorus poisoning were included in the study. Total number of such study subjects were 200.

Statistical Analysis: The statistical analysis was carried out using proportions.

Results:

A total of 51,745 patients were admitted in the Shri Guru Gobind Singhji Memorial Hospital, Nanded during the study period, out of that 1,082 (2.09%) were cases of poisoning. Out of this 1,082 poisoning cases, 200 i.e. 18.48% were cases of Organophosphorus compound poisoning. Thus the incidence of Organophosphorus compound poisoning among all poisoning cases was 18.48% and 0.39% among all the patients admitted during the study year.

Table 1 shows age and sex distribution of cases of Organophosphorus compound poisoning. Maximum cases (41%) were in the 21 – 30 years of age group followed by 12 – 20 years. Only 1.50% cases were above the age of 60 years. Male predominance was clearly seen i.e. 77.50% cases were males and only 22.50% cases were females with male to female ratio of 3.4:1.

Marital status of cases is shown in figure 1. Both among males and females, maximum cases were married i.e. 68.34% in males and 71.11% in females. Figure 2 shows literacy status of Organophosphorus poisoning patients. It is seen that as the level of literacy increased the incidence of Organophosphorus poisoning is decreasing, i.e. it is 30% among illiterates and only 2% among those who graduated or had higher level of education.

Figure 3 shows the family income per month of Organophosphorus poisoning patients. The incidence of Organophosphorus poisoning was found more in higher income group than those in the lower income group. Distribution of Organophosphorus poisoning patients according to their occupation is shown in table 2. As expected, maximum cases were found among farmers and only 0.50% cases reported among doctors.

Route of Organophosphorus poisoning among patients is shown in table 6. Ingestion is the most common route of poisoning as seen in 99% of patients. Figure 5 shows types of Organophosphorus poisoning. 80.50% cases of poisoning were of suicidal type whereas in 9.50% of cases Organophosphorus poisoning was used for homicide purpose.

Table 3 shows reasons for intake of Organophosphorus poisoning. Maximum i.e. 29.50% of poisoning cases were due to family conflict followed by marital conflict/disharmony (16%) and 12% due to financial loss/economic hardship.

Monthwise distribution of Organophosphorus poisoning cases is shown in table 4. Maximum number of patients were reported in the month of September (17.5%) followed by August (14.5%), June (11%), April (10.5%), October (10%) and July (9%) which are usual months for spraying insecticides on crops.

Table 5 shows nature of Organophosphorus compound used. Most common Organophosphorus compound used for poisoning purpose was Roger i.e. Dimethoate in 43.5% followed by mixed poisoning (18.5%), Novacron (5.5%), Chloropyrifos (4%), Monocrotophos (2.5%) and Cypermethrin (2.5%).

Discussion:

The present study was carried out in the Department of Medicine, Government Medical College and Shri Guru Gobind Singhji Memorial Hospital, Nanded during September 2002 to August 2003. This study comprises of 200 patients of Organophosphorus compound poisoning with incidence of 18.48%.

The age of patients ranged between 12 to 70 years. Most of the patients were in the age group of 21 to 30 years (41%). The patients below the age of 40 years were 88.50%. Kulkarni R [6] who had done study on neurological manifestations of Organophosphorus compound poisoning also reported that 89% of patients were below the age of 40 years. Mutalik et al, [2] Balani et al [7] and Vishwanathan [8] made similar observations. There were 155 (77.5%) males and 45 (22.5%) females with male to female ratio being 3.4:1 showing male preponderance. As most of the male patients are farmers, they have easy accessibility to this Organophosphorus poison, as they are active members involved in spraying of insecticides. Kulkarni R, [6] Anil Kamble [9] and Thomas Chang et al [10] reported similar observation of male preponderance.

In the present study, the incidence of Organophosphorus poisoning was common amongst the married population i.e. 138 (69%). Anant Mulay [11] and Siwach and Gupta [12] also reported highest incidence in married population. This may be because of family and economical problems which are more common in married population.

In the present study, the incidence of poisoning was more among illiterate patients and patients educated below 10th standard. Similar trend was observed by Anant Mulay [11] and Siwach and Gupta. [12] Most of the patients were from low socioeconomic group having below poverty line card. S. Singh [13] reported more population belongs to lower socioeconomic group.

The most common mode of poisoning was ingestion (99%) followed by inhalation. Kulkarni R, [6] observed ingestion as the most common mode of poisoning (93%) and 7% by other routes.   Mutalik et al, [2] Balani et al, [7] have observed oral ingestion as a common route of poisoning.

The commonest type of poisoning was suicidal 161 (80.5%) followed by homicidal 19 (9.5%) and accidental in 10 (5%) of patients. Kulkarni R, [6] Balani et al, [7] Anil Kamble, [9] Mutalik et al, [2] S. Singh [13] also observed that incidence of suicidal intention with Organophosphorous compounds was major cause of poisoning.

In the present study, most common reason for intake of poison observed is family conflict (29.5%) followed by marital conflict (16%), financial loss/economic hardship (12%) and scolding from elder person in 11%. Anant Mulay [11] reported family conflict as the most common reason in 69.7% of poisoning patients and financial loss in 4.8%. Siwach SB and Gupta [12] reported marital disharmony in 32.7% of cases, economic hardship in 15.3% and disagreement or scolding from family members in 11.6% as important reasons for intake of poison. Gupta SC [14] evaluated Organophosphorus poisoning patients by suicidal intent questionnaire and found that most of the patients were having psychiatric illness which remains unnoticed during clinical interview.

We observed that most of the patients reported in September (17.5%) followed by August, June, April and October. Anant Mulay [11] also observed most patients in October followed by September. This may be due to the fact that June to October is the usual months for spraying insecticides and hence compounds are easily accessible.

In the present study, Roger (Dimethoate) was the most common compound in 43.5% cases used for poisoning. In 40% of cases the nature of the compound cannot be ruled out (unknown). Mixed compound poisoning was observed in 18.5% of patients followed by Novacron (5.5%), chloropyrifos (4%) and Monocrotophos in 2.5%. Roger was the most common Organophosphorus compound used for poisoning due to its easy availability and its usefulness in many crops as insecticide. Kulkarni R [6] and Anil Kamble [9] also reported that Roger was the most common compound used for poisoning in 69% and 59.38% respectively. Mutalik et al [2] reported 25 patients of Diazinon poisoning which is chemically related to parathion a Organophosphorus compound and is believed to be less toxic. According to him, diazinon was freely available as an insecticide which may be the underlying reason of its increasing frequency as suicidal agent. Wadia RS et al [15] reported 150 cases out of which 50 had consumed malathion, 48 sumithion and 32 had consumed fenithion.

This study was conducted for whole one year involving patients from all age groups and at a set up where maximum cases are reported. The results obtained fairly represent the subject concerned as in one year we have covered all 200 patients. Thus we found that maximum cases were in the age group of 21 – 30 years, married group and among farmers and reported during June to October. Ingestion was the most common route of poisoning and family and marital conflicts were the most common reasons leading to poisoning. Among insecticides, Roger was the most common compound used for poisoning.

References:

  1. Patial RK, Bansal SK, Sehagal VK, Chander B. Sphincteric involvement in Organophosphorus poisoning. J Assoc Physicians India 1991 Jun;39(6):492-3
  2. Mutalik GS, Wadia RS, Pai VR. Poisoning by Diazinon, an Organophosphorus insecticide. J Indian Med Assoc. 1962 Jan 16;38:67-71.
  3. Ellenhorn MJ. Ellenhorn’s Medical Toxicology. Diagnosis and Treatment of Human Poisoning. 2nd Baltimore Md. Lippincott Williams and Wilkins; 1997.
  4. Singh NP, Kaur G. Poisoning – Basic Considerations and Epidemiology. In: Munjal YP, editor. API Textbook of Medicine, 9th New Delhi: Jaypee Brothers;2012. p. 1934-5
  5. Tandon SK, Singh S, Jain VK, Prasad S. Chelation in metal intoxication. XXXVIII: Effect of structurally different chelating agents in treatment of nickel intoxication in rat. Fundam Appl Toxicol 1996 Jun;31(2):141-8.
  6. Kulkarni R. Neurological manifestations of Organophosphorus compound poisoning. Dessertation for M.D. (General Medicine) at B.A.M. University 1996.
  7. Balani SG, Fernandes SO, Lakhani RH, Juthani VJ. Diazinon poisoning. A report on 100 cases with particular reference to evaluation of treatment. J Assoc Physicians India. 1968 Nov;16(11):911-7.
  8. Viswanathan M, Srinivasan K. Poisoning by bug poison. J Indian Med Assoc. 1962 Oct 1;39:345-9.
  9. Anil Kamble. Respiratory paralysis in Organophosphorus poisoning. Dissertation for M.D. (General Medicine) at B.A.M. University 2001.
  10. Tsao TC, Juang YC, Lan RS, Shieh WB, Lee CH. Respiratory failure of acute organophosphate and carbamate poisoning. Chest. 1990 Sep;98(3):631-6.
  11. Anant Mulay. Clinical profile of acute poisoning in adults. Dissertation for M.D. (General Medicine) at B.A.M. University 2001.
  12. Siwach SB, Gupta A. The profile of acute poisonings in Harayana-Rohtak Study. J Assoc Physicians India. 1995 Nov;43(11):756-9.
  13. Singh S, Sharma BK, Wahi PL, Anand BS, Chugh KS. Spectrum of acute poisoning in adults (10 year experience). J Assoc Physicians India. 1984 Jul;32(7):561-3.
  14. Gupta SC, Anand R, Trivedi JK. Development of a suicidal intent questionnaire. Indian J Psychiatry. 1983 Jan;25(1):57-62.
  15. Wadia RS, Sadagopan C, Amin RB, Sardesai HV. Neurological manifestations of organophosphorous insecticide poisoning. J Neurol Neurosurg Psychiatry. 1974 Jul;37(7):841-7.

Tables:

Table 1: Age and sex distribution of cases of Organophosphorus poisoning

Age (years)

Male

Female

Total

12 – 20

33 (21.3)*

18 (40.0)

51 (25.5)

21 – 30

69 (44.6)

13 (28.9)

82 (41.0)

31 – 40

34 (21.9)

10 (22.2)

44 (22.0)

41 – 50

09 (05.8)

04 (08.9)

13 (06.5)

51 – 60

07 (04.5)

00 (00.0)

07 (03.5)

> 60

03 (01.9)

00 (00.0)

03 (01.5)

Total

155 (77.5)

045 (22.5)

200 (100)

*Figures in the parentheses indicate percentages

Table 2: Distribution of patients according to their occupation

Occupation

No. of cases

Farmer

131 (65.5)*

Housewife

37 (18.5)

Labourer

14 (07.0)

Student

09 (04.5)

Service

07 (03.5)

Businessmen

01 (00.5)

Doctor

01 (00.5)

Total

200 (100)

*Figures in the parentheses indicate percentages

Table 3: Reasons for intake of Organophosphorus poisoning

Sl. No.

Reason

No. of cases

1

Family conflict

59 (29.5)*

2

Marital conflict/disharmony

32 (16.0)

3

Financial loss/economic hardship

24 (12.0)

4

Scolding from elder person

22 (11.0)

5

Physical illness

11 (05.5)

6

During removal of nozzle of bottle

11 (05.5)

7

Unknown

10 (05.0)

8

During spraying

10 (05.0)

9

Psychiatric illness

09 (04.5)

10

Academic worries

04 (02.0)

11

Under influence of alcohol

03 (01.5)

12

After death of only child

02 (01.0)

13

Failure in love

01 (00.5)

14

Unemployment

01 (00.5)

15

Dowry death

01 (00.5)

 

Total

200 (100)

*Figures in the parentheses indicate percentages

Table 4: Month wise distribution of Organophosphorus poisoning cases

Month

No. of cases

September

35 (17.5)*

October

20 (10.0)

November

07 (03.5)

December

09 (04.5)

January

05 (02.5)

February

04 (02.0)

March

14 (07.0)

April

21 (10.5)

May

16 (08.0)

June

22 (11.0)

July

18 (09.0)

August

29 (14.5)

Total

200 (100)

*Figures in the parentheses indicate percentages

Table 5: Distribution as per type of Organophosphorus compound used.

Type of compound

No. of cases

Roger (dimethioate)

87 (43.5)*

Unknown

80 (40.0)

Mixed

37 (18.5)

Novacron

11 (05.5)

Chloropyrifos

08 (04.0)

Monocrotophos

05 (02.5)

Cypermethrin

05 (02.5)

Quinalphos

04 (02.0)

Phenolphos

04 (02.0)

Pyrethrin

01 (00.5)

Unmet powder

01 (00.5)

Thymate powder

01 (00.5)

*Figures in the parentheses indicate percentages

Table 6: Patient distribution as per route of Organophosphorus poisoning

Route

No. of Patients

Ingestion

198 (99.0)*

Inhalation

 

 

 

 

 

 

001 (00.5)

Intravenous

001 (00.5)

Both ingestion and inhalation

017 (08.5)

Figure 1, 2 & 3: PLEASE REFER FROM PDF FILE

Source of Support: Nil. Conflict of Interest: None.

 

 





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