Poisoning in children--analysis of 250 cases.
This study is an analysis of 250 cases over a period of 2 years, admitted to our hospital for various poisonings. The total incidence of poisoning was 11.9%, much higher as compared to the other series. Of these, 58.4% were seen in the age group of 1-4 years. Male to female ratio was 1.7:1. Incidence of food poisoning was 48.8% followed by that of kerosene (24%), pesticides (9.6%), chemicals and medicaments (8.4%), plant (3.6%) and animal bites (3.2%). Overall mortality was 0.8%.
For every fatal accidental poisoning in a child, there are about 100 non-fatal accidental poisonings requiring admission. It was therefore, decided to analyse the cases of poisoning in children admitted in our hospital to determine the incidence and etiological agents.
Two hundred and fifty cases of poisoning in children admitted to Dr. RN Cooper Municipal General Hospital over a period of two years (1986-1987) were studied. Animal bites were also included. Regarding selection of food poisoning cases for inclusion in the study, we have excluded solitary cases to avoid over diagnosis. Bacteriological and endotoxin assay to exclude cases of gastroenteritis not related to food was not possible with the facilities available to us. Hence only those cases where 2 or more patients apparently well before consumption of a particular food item were included in the study. In many of these cases a history of simultaneous admission of relatives in the medical ward for similar complaints was obtained. The data collected from the case record forms were analysed for agent responsible, age-sex distribution pattern and mortality.
The 250 cases of poisoning constituted 11.9% of the total admissions to the Paediatric wards during 2 years' period. Analysis of data of these cases is presented in [Table - 1]. The maximum incidence of poisoning was observed in the age group of 1-4 years (146/250; 58.4%) though in general the age ranged from 6 months to 12 years. Male to female ratio was 1.7:1. Only 2 cases were of intentional poisoning, one with alcohol and other with imipramine and chlordiazepoxide, the rest were accidental.
Food poisoning was found to be the commonest, the incidence being 48.8%. In 82% of these cases milk products like sweetmeats (pedhas, burfi) eaten on festive occasions were the causative factors. In the remaining cases, stale vegetable preparations and leftover food items were responsible for poisoning.
All the cases of kerosene poisoning were infants (n = 2) and toddlers (53 in the age group of 1-2 years and 5 of 3-4 years). When left unattended, they accidentally ingested kerosene, kept on ground within their reach. The common presenting features in these children were fever (in 52 of 60) and dyspnea (in 35 of 60). Thirty patients developed aspiration pneumonia and 2, convulsions and coma, of whom one expired. Thus mortality in this group was 1.6%.
Pesticidal poisoning occurred in 9.6% cases. The pesticides encountered were Tik 20 in 7, Baygon in 6, benzyl benzoate in 5, rat poison in 3, naphthalene in 2 and gammabenene hexachloride in 1. No complications were seen in naphthalene poisoning.
[Table - 2] illustrates the chemicals and medicaments contributing to poisoning, the incidence of which was 8.4%. An 11-year-old boy, suffering from obsessive compulsive neurosis intentionally overdosed himself with imipramine and chlordiazepoxide and presented with convulsions and coma. He recovered uneventfully following treatment with inj. neostigmine (0.04 mg/kg i.m.) and activated charcoal 10 gin 4 hourly for one day.
Plant poisoning comprised 3.6% cases. Dhattura and castor seeds were consumed by 3 cases each, while the rest 3 were due to unknown plant products. None of them developed complication on required treatment.
Eight cases were of animal bites (3.2%); 6 due to snake bite (2 due to poisonous and 4 non-poisonous snakes) and 2, of unknown animals. The snake-bite poisoning was treated with anti-snake venom and supportive measures but one case died due to neurotoxicity.
Corrosive acid poisoning was seen in 0.8% cases. Miscellaneous agents comprised 1.6%, and these were alcohol in 2 cases, antidandruff preparation and fire crackers in 1 case each. Alcoholic poisoning in a 4 year old child occurred as his alcoholic father forced him to consume country liquor. The child developed hematemesis and coma but recovered after therapy with i.v. dextrose, vit. K, thiamine and cimetidine.
Poisoning in children is a global problem. With increasing use of various chemical substances and change in the environment the incidence is on the increase. A comparative data of incidences of poisoning as reported over a period of 30 years in various parts of our country is presented in [Table - 3]. The incidence has ranged from 0.33%11 to 7.64%2. As compared to this, our incidence 11.9% is high. Following may be the reasons: (a) The place of this study is a major referral hospital in the peripheral suburbs of Greater Bombay. (b) Coroner's Court is attached to the hospital and poisonings, being medico-legal cases are often admitted here. (c) We have included cases of food poisoning in the study, which were not included by some of the previous workers.
We found that the incidence is more common in males, between the age group of 1-4 years and with food poisoning. Some are the findings of Sitaraman et al Others have reported variable incidences of food poisoning ranging from 6.6%1 to 42.3%.
In majority of the studies kerosene oil was the most common etiological agent,,,,,,,,,, which resulted in 0.8% - 3.4% mortality. Our mortality rate was 1.6%. As in all these studies it occurred in unattended toddlers, from the public view point we wish to re-emphasise the need of their attention at all times and keeping kerosene out of their reach, preferably under lock.
Our incidence of pesticides, chemicals and medication, and plant poisoning are 9.6%, 8.4% and 6.2% respectively. Previous reports have stated the incidence of 4.9% and 6.2% for pesticide and plant poisoning. As compared to other studies,,,,,,,,,, we found a decreased rate of medication poisoning; this may be due to increased awareness of home safety measures. Incidence of animal bite poisoning as reported by Chatterjee and Banerjee is 4.76%.
The overall mortality rate in our series is of 0.8%. A significant decrease in mortality rate is seen as compared to that reported by Manchanda and Sood 30 years ago. However, in view of rising incidence of poisoning, a health education of parents for adoption of simple home safety measures should be promoted.