patterns of toxicology cases in a tertiary care hospital, aggresive management of acidosis in celphos poisoning by means of hemodialysis , SBC infusion. 100 percent survival in organophosphate

1. Dr pramod sarwa

2.  Poison is a substance that causes damage or injury to the
body and endangers one’s life due to its exposure by means of
ingestion, 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 theWorld 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

3.  According toWorld 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)

4.  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.)

5. 0%unknown, 6,
8%
op, 19, 26%
celphose, 18, 24%
snake bite, 15, 20%
rat poison, 4, 6%
acid, 2, 3%
scorpion/bee/animal,
3, 4%
kerosene, 1, 1%
miscell, 6, 8%
Other, 12, 16%
poisoning cases

6. 0
1
2
3
4
5
6
7
8
9
10
4
10
8
9
2
0
1
0
42
8
9
6
2
2
2
1
2
male
female

7. 2
8
7
1
1
1
2
1
6
19
18
15
4
2
3
1
6 unknown
op
celphose
snake bite
rat poison
acid
scorpion/bee/animal
kerosene
miscell

8. 1
11
1
6
19
18
15
4
2
3
1
6
unknown
op
celphose
snake bite
rat poison
acid
scorpion/bee/animal
kerosene
miscell

9. 0
1
2
3
4
5
6
avg icu stay in days
avg stay in days

10. 0
2
4
6
8
10
12
14
16
18
6
18
17
15
4
2
3
1
6
3
18
8
15
4
2
1 1
6
number of cases
survived

11.  OP……..100%
 Snake bite…100%
 Celphos…50%
 Acid ingestion..100%
 Rat poison ..100%
 Kerosene ..100%
 Unknown poison..50%
 Miscellaneous 100% (phenol,terpentine, alcohol, neem,
dhatura
Nitrobenzene )

12. 0
1
2
3
4
5
6
7
8
5
8
6
1
2
3
0
22
8
6
1
2
1
0
2
2013
survival in 13

13. 0
2
4
6
8
10
12
1
11
9
3
0 0
1
4
1
11
9
3
0 0
1
4
2014
surival in14

14.  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. ClinToxicol (Phila) 2009;47:89–
100. [PubMed

15. 11
5
3
1 1
0
2
4
6
8
10
12
number of cases crrt/hd survived survived with RRT survived without RRT
before july14
before july14

16. 0
1
2
3
4
5
6
7
number of cases crrt/hd survived survived with RRT survived without RRT
7
6 6 6
0
after july 14
after july 14

17. 0
2
4
6
8
10
12
number crrt/hd survived survived with RRT survived without
RRT
11
5
3
1 1
6
5 5 5
0
before july14
after july 14
After july 2014..
85.71%
cases

18.  very aggressive management of metabolic
acidosis
 early institution of HD/CRRT/SLED
 massive bicarbonate therapy

19.  Apart from decontamination , supportive
treatment ,important role of
 Early PCT
 Early mechanical ventilation
 PAM in non carbamate poisoning

20.  ASV
 Early identification and management of
complication like
 intracranial hemorrhage
 coagulopathy
 muscle weakness
 necrosis

21.  Early identification
 Definitive care
 Early aggressive management
 Recognition of complications
 Management of complication
 Documentation