Short Communication
POISONING IN CHILDREN
Khurshid Ahmad Wani MD; Mushtaq Ahmad MD; Rauf-ur-Rashid Kaul MD; A S Sethi MD;
Shabnum MBBS
Authors’ affiliations:
Khurshid Ahmad Wani,
Mushtaq Ahmad, Prof. A S
Sethi
Department Of Peadiatrics
Rauf-ur-Rashid Koul
Department of SPM
Govt. Medical College,
Srinagar
Shabnum
Asstt. Surgeon DTC Pulwama,
Kashmir.
Accepted for publication:
June 2004
JK - Practitioner 2004; 11(4):274-
275
Correspondence to:
Poisoning is a Pediatric
emergency and a thorough knowledge
about the nature and magnitude of
problem especially when associated with
regional peculiarities is necessary.
Pediatric reports 1-8 from various centers
reveal the much needed intonation and
changing spectrum. This study was
conducted in Govt. Hospital for Children,
Srinagar, the major referral hospital for
pediatrics” catering to the whole Kashmir
Valley.
During this entire period (4 years),
out of 67,59,599 admissions, accidental
poisoning accounted for a total of 650
cases (0.96%),out of which 130 cases
(0.75%)were in 1997,90 (0.58%)in 1998,
180 ( 1.2%) in 1999 and 250 ( 1.25%) in
2000.
Maximum number of cases
(49.8%)were in the age group of 1-5 years
and least (4.2%) were below I year of age.
46% of case were above 4 years of age
group the male female ratio was 1.15:1
where as the rural! urban ratio was 1.6
Kerosene oil was the leading
poison consumed in all the four
comparative years (39.25%) where as food
poisoning was the least encountered
poisoning (2.4%)
Over all mortality rate was I
6%.A total of eleven patients died during
hospital stay .Highest number of deaths
were in 1997 (4 out of 130) and lowest in
2000 (2 out of 250 cases).
The incidence of poisoning has
shown a considerable variation with
reported incidence ranging form 2.0 to
5.1%I-8V,however in our study, the
incident is 0.96%.This lesser incidence
in the present series is probably due to
better awareness of parents keeping
away poisonous substance out of the
reach of children and better medical
facilities and pediatric care being available
in the peripheral areas and some patients
well managed at catchments area. In the
age distribution our findings are in
conformity with the retrospective study
reported by Buch etal in 19913 trom the
children hospital in Srinagar. Incidence
was reported as (49.8%) in the age group
of 1-5years and 4.2 % below 1 year
Vol. 11, No. 4, October-December 2004
JK-PRACTITIONER
of age. This is in accordance with the
observation of American sub-committee
report, they also found majority of the
children belonged to the group of 1-3
years. This predilection of age group is
related the oral exploration of the
environment during this phase of growth
with increasing mobility of child during
this period5.
Kerosene Oil: Remains the commonest
household substance involved in
accidental ingestion, it accounted for
40.7% of our cases though other studies
7, 8
, have reported an incidence of 33.7%,
55%. Kerosene oil ingestion results in
toxicity of gastrointestinal, respiratory
and central nervous system 2, 5 Aspiration
pneumonia was the commonest
complication observed but responded
within 1-2 weeks. CNS complications were
noted in 25 cases. These cases had good
prognosis. There was no mortality in
kerosene group.
Pesticide Poisoning has shown
an appreciable rise (20.5%) compared with
previous reports 7,8 of 4.9 to 9.2%. Organ
phosphorus compounds like tick-20 and
Finite. (fenitrothium) are increasingly
being used for pest control in houses,
constituted many cases.
Organophosphorus compounds are
frequently used in the valley for fruit
crops and accounted for more than 5% of
cases in our study. Organophosphorus
poisoning has increased dramatically
over past few years because of easy
availability of pesticides especially in rural
areas. Plant Poisoning Constituted
(15.2%) of poisoning cases in our study,
of which more than 50% were due to
Datura Poisoning and the remaining
(6.3%) were due to consumption of wild
seeds which were identified as those of
Coria ria neplansis .The fruits commonly
known as masoori bari are poisonous and
were earlier used to make fly poisons and
adulterant for sena .The patients present
with symptoms typical of tetanus.
All such cases had an
uneventful course other than
convulsions, being managed
conservatively. Buch etal3 reported plant
274

poisoning in 13.4% of cases, of which 20% were constituted
by wild fiuit. Majority had symptoms typical of tetanus; there
was lone
fatality in their study.
Food Poisoning: was encountered in (3.2% }of cases where
as earlier studiesI,2,9,12 have reported incidence ranging from
6.6% to 42.3%.This low incidence is probably due to climatic
conditions ofthe valley.3 patients died due to food poisoning
in this series. S. Sitaram9in their study reported (32.2%) cases
of food poisoning where as Buch etal reported 3.9% of cases
of poisoning as food poisoning, which was consistent with
our study.
Corrosive poisoning: was least common (2.4%) in our series,
mostly due to caustic soda. The cases were managed
conservatively and recovered without any complications.
Buch etal3 reported corrosive poisoning in (2.7%) cases,
mostly due to caustic soda. Poisoning by medication and
chemicals have not shown any Perceptible increase unlike in
developed countries where they are posing a major threat10 .
In the presentseriesthey constitute 15.5%. In the
miscellaneous group commonest poisoning was ingestion
of mosquito repellents especially Good knight because of
attractive covering. Other peculiar substances were
Naphthalene balls, insect killer; Nail polish remover .Buch
etae reported that medications and chemicals were responsible
for the maximum number of cases (33%). This was definitely
higher than that reported in our study. Main reasons being
less use of matoclopromides as antiemitic. Of particular interest
were cases of favism in contraindication to previous studies
of rarity of GFD deficiency in valley. To conclude, keeping
drugs out of reach of children, storing the house hold fuel like
kerosene safely, providing immediate medical aid when
275 Vol. 11, No. 4, October-December 2004
JK-PRACTITIONER
poisoning occurs and last but not least prescribing drugs
more carefully will go along way in preventing hospital
admissions and mortality .Creation of more and more poison
control cells and general awareness about there role, will help
to govern the management of effected cases properly,
facilitating proper antedates and upto date knowledge about
the management.
REFFERENCES.
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Indian Pediatric 1974; 9:617-621.
2. Buhariwalla R J, Sajanwalla. Poisoning in children, A
study of 303 cases. Indian Pediatric 1969; 6:141- 145.
3. Buch N, Kaiser A, Sethi A.S, Poisoning in children. Indian
Pediatric 1991; 28:521- 524.
4. Chatterjee B, Benerjee AP. Accidental Poisoning in
children. Indian pediatric 1981; 18:157-162.
5. Report of sub-Committee on Accidental Poisoning, Co-
operative Kerosene Poisoning study. Pediatric 1962;
29:648-679.
6. Sanatbanakrisbnan R. Balagopal R V. Poisoning in
childhood. Indian J. Pediatrics 1972; 39:158-164.
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Jaipur. Indian Pediatric 1974; 41:174-178
8. Satbpathy R., Das B B. Accidental poisoning in children.
J Indian Med. Assoc.1979; 73:190-192.
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Indian Pediatric 1985; 22:757-760
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Clinic North America, 1970; 17:713- 727
11. Talati S, Gandhi VK. Accidental poisoning in children.
Pediatric Clinic India 1973; 8:65-70
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study. Pediatric clinicIndia.1980; 15:23-25