Acute pesticide poisoning: 15 years experience of a large North-West Indian hospital

Introduction. Acute pesticide poisoning is an important cause of morbidity and mortality in developing countries. Better preventive and management strategies can be developed if the incidence and pattern of acute poisoning are known. Methods. This retrospective study covered 15 years (1990 to 2004). The case records of all cases admitted with acute poisoning during these years were reviewed and the results compared to earlier studies. Results. A total of 2884 patients with acute poisoning were admitted during the study period (1918 men). The mean age was 27.8 years (range 13 to 82 years). The commonest agents were anticholinesterases (35.1%) and aluminum phosphide (26.1%). A seasonal variation in anticholinesterase poisoning was observed (most cases occurring July to September) but not for aluminum phosphide. No difference in mortality was observed over different months for different agents. Maximum case fatality ratio was due to aluminum phosphide exposures followed by anticholinesterase agents. The case fatality ratios for aluminum phosphide and organophosphate poisonings declined since 2000 despite an increase in aluminum phosphide exposures. The decline in aluminum phosphide mortality may be due to limited availability of 3 gm tablets and improved intensive care. Conclusions. Though incidence of acute pesticide poisoning increased over decades, there has been a decline in mortality for both aluminum phosphide and anticholinesterases. There is still need for measures like integrated pesticide management, development of safer aluminum phosphide formulations, and training of farmers in spraying techniques.