Poisoning is a significant global public health problem, leading to substantial morbidity and mortality. It can occur due to exposure to various toxic substances, including household chemicals, pharmaceuticals, pesticides, industrial chemicals, and natural toxins. Poisoning can be intentional (suicidal or homicidal) or accidental, with a wide spectrum of clinical presentations ranging from mild gastrointestinal symptoms to severe systemic toxicity.^[1] The prevalence and pattern of poisoning vary by geographical region, socio-economic factors, and the availability of toxic substances. Acute poisoning is an important cause of emergency hospital admissions worldwide. The World Health Organization (WHO) estimates that poisoning accounts for a significant number of deaths annually, with the majority occurring in low- and middle-income countries.^[2] In India, poisoning is one of the leading causes of hospitalization and mortality, particularly in rural areas where access to healthcare is limited. Pesticides, especially organophosphorus compounds, are among the most common toxic agents encountered in cases of poisoning in India, primarily due to their widespread use in agriculture. Other common toxic substances include household chemicals, pharmaceuticals, snake venom, and industrial toxins.^[2,3]

The clinical manifestations of poisoning depend on the nature and dose of the toxic substance, the route of exposure, and the time elapsed before medical intervention. Symptoms may include nausea, vomiting, respiratory distress, neurological impairment, cardiovascular instability, and multi-organ failure. Early recognition and prompt treatment are crucial in reducing morbidity and mortality. Standard treatment approaches include decontamination, supportive care, administration of specific antidotes, and enhanced elimination techniques.^[4] The epidemiological trends of poisoning have evolved over time, influenced by factors such as changes in agricultural practices, industrialization, and increasing access to medications. Suicide by poisoning remains a major concern in India, especially among young adults. Accidental poisoning is common among children due to easy accessibility to toxic substances at home. The lack of awareness about the dangers of household and agricultural chemicals contributes significantly to poisoning cases.^[5]

This study analyzed the clinical profile and outcomes of patients with acute poisoning. It examined demographics, common toxic agents, clinical presentations, and treatment approaches to improve management strategies. Findings provide insights into poisoning patterns, treatment effectiveness, and associated risk factors, aiding in public health interventions and preventive measures to reduce poisoning-related morbidity and mortality.

This study was designed as a prospective observational study conducted over one year from August 2022 to August 2023. The study was carried out in the Department of General Medicine and Intensive Care Units (ICUs) at Mahatma Gandhi Mission’s Medical College and Hospital, Navi Mumbai, a tertiary care hospital with 1700 beds, catering to a population of approximately 1,000,000 individuals. The study population included individuals above 18 years of age, presenting with confirmed or suspected poisoning, irrespective of the type, mode, and severity of poisoning. Both intentional (suicidal) and accidental cases were included. Exclusion criteria comprised patients with conditions mimicking poisoning but not caused by toxic substances, cases with incomplete medical records, those who did not require hospitalization, and patients with a history of alcohol consumption within the past 24 hours, pre-existing bleeding disorders, or on anticoagulant therapy.

The sample size for this study was determined based on statistical calculations to ensure adequate power for meaningful analysis. Considering a 95% confidence level, a margin of error of 7%, and an assumed prevalence of 15% from previous studies, the estimated sample size was 100 patients. To account for possible non-responses or dropouts, an additional 5% was included, leading to a final sample size of 105 patients. Data collection was systematic and structured, involving the use of a standardized data collection form. Informed consent was obtained from all participants or their legal guardians before enrollment. Data collected included demographic details, clinical presentation, type of poison, route and circumstances of exposure, laboratory findings, treatment received, and clinical outcomes.

Clinical assessments involved documentation of symptoms, vital signs (blood pressure, heart rate, respiratory rate, temperature), and type of poisoning. Laboratory investigations, including toxicology screens, blood tests, and other diagnostic procedures, were recorded. Treatment interventions such as gastric lavage, administration of activated charcoal, antidotes, supportive measures, and the need for mechanical ventilation were noted. Patients were followed up during their hospital stay to assess morbidity, mortality, and treatment outcomes. This methodology ensured a comprehensive evaluation of poisoning cases, allowing for an in-depth analysis of clinical profiles, treatment strategies, and patient outcomes.

Data were analyzed using IBM SPSS Statistics 26.0. Descriptive statistics summarized findings through frequencies, percentages, and measures of central tendency. Chi-square tests assessed associations between categorical variables, while t-tests compared continuous variables. A p-value <0.05 was considered statistically significant.

The Results section presents the analysis of acute poisoning cases, focusing on demographic characteristics, clinical presentations, treatment interventions, and patient outcomes. The association between time to hospitalization, type of poisoning, route of exposure, complications, and survival status is examined using statistical methods. Significant findings highlight the impact of early medical intervention and specific clinical parameters on patient prognosis.

The table 1 indicates that majority of the poisoning cases (41.9%) occurred in the 21-30 years age group, followed by 31-40 years (21.9%), with fewer cases in older individuals. Females (59.0%) were more affected than males (41.0%). The distribution of marital status was nearly equal, with 50.5% unmarried and 49.5% married. Most cases were from urban areas (68.6%), suggesting higher poisoning incidence or better healthcare accessibility in urban settings. In terms of education, high school (31.4%) was the most common level, while graduates and postgraduates comprised 20.9% of cases.

Farmers (33.3%) and laborers (25.7%) were the most affected occupational groups, likely due to pesticide exposure, followed by housewives (20.0%). Socioeconomic analysis showed that the highest proportion of cases belonged to the lower (32.4%) and upper lower (30.5%) classes, suggesting a potential link between poisoning and financial stress or occupational hazards.

Table 2 indicates that suicidal poisoning (84.8%) was the most common mode of exposure, while accidental poisoning accounted for 15.2% of cases. Among the types of poisoning, household products (51.4%) were the most frequently involved, followed by pesticides (26.7%) and pharmaceutical agents (12.4%), with a small proportion of cases involving unknown (6.7%) or other substances (2.9%). The oral route (90.5%) was the predominant mode of exposure, while skin exposure (6.7%) was less frequent. In terms of symptoms, neurologic (38.1%) and gastrointestinal symptoms (37.1%) were the most commonly reported, followed by respiratory (9.5%), other symptoms (12.4%), and cardiovascular involvement (2.9%). These findings highlight the predominance of intentional poisoning, particularly with household and pesticide products, and the importance of early recognition of neurological and gastrointestinal symptoms in acute poisoning cases.

Table 3 indicates a significant association between the time interval to hospitalization and patient outcomes, with survival rates being highest (85.7%) among those admitted within two hours, while mortality increased to 66.7% in those admitted after eight hours (p < 0.014). The administration of stomach wash did not show a statistically significant impact on survival (p = 0.386). Suicidal poisoning cases had a higher mortality rate (22.5%) compared to accidental cases (18.8%), with a significant association (p < 0.01). Among the types of poisoning, pharmaceutical agents (46.2%) and unknown substances (42.9%) had the highest fatality rates, but this association was not statistically significant (p = 0.083). The route of exposure did not show a significant correlation with outcome (p = 0.563), though patients with gastrointestinal (28.2%) and neurologic (15.0%) symptoms had varied survival rates. The presence of **complications had a strong association with mortality (p < 0.001), with hepatic failure (54.5%) and ventilator-associated pneumonia (VAP) (66.7%) being the most fatal conditions. These findings highlight the critical importance of early hospitalization and the need for aggressive management of complications in acute poisoning cases.

Table 4 presents a comparison of baseline hemodynamic and biochemical parameters among survivors and non-survivors of acute poisoning cases. Significant differences were observed in respiratory rate (p = 0.046), SpO₂ (p < 0.001), hemoglobin (p = 0.018), total leukocyte count (p = 0.01), total bilirubin (p = 0.011), and SGOT levels (p = 0.01), indicating their potential role in predicting patient outcomes. Survivors had a higher mean SpO₂ (92.56 ± 11.30) compared to non-survivors (80.20 ± 6.74), suggesting that oxygen saturation is a crucial prognostic marker. Total leukocyte count was significantly lower in non-survivors (6297.46 ± 2075.38) compared to survivors (7654.81 ± 1956.83), indicating possible immune dysfunction. In contrast, parameters such as pulse rate, serum cholinesterase, platelet count, urea, creatinine, ALP, SGPT, and RBS did not show statistically significant differences, suggesting a limited role in predicting mortality. These findings emphasize the importance of monitoring respiratory function, oxygen saturation, liver enzymes, and inflammatory markers for early risk stratification in acute poisoning cases.

This prospective observational study examined the clinical profile, management, and outcomes of acute poisoning cases in a tertiary care hospital. The study included adults above 18 years of age who presented with poisoning due to various toxins. It focused on demographic factors, types of poisoning, clinical manifestations, treatment interventions, and prognostic indicators affecting survival rates. Data collection was structured, ensuring ethical compliance, informed consent, and patient confidentiality.

The findings revealed a higher incidence of poisoning among young adults (21-30 years), consistent with previous research by Aher et al.^[3] who attributed this trend to stress, job insecurity, relationship issues, and family conflicts. While suicidal intent accounted for the majority of cases, accidental poisoning was also observed, particularly among men, aligning with studies by Bhadade R et al.^[6], Adinew GM et al.^[4], and Aggrawal et al.^[7], who found that men are more likely to experience poisoning due to occupational exposure and life stressors. Rural residents and individuals from lower socioeconomic backgrounds were more affected, likely due to economic distress, crop failures, and easy access to toxic substances, as noted by Bhadade et al.^[6] and Rohini R et al.^[8]

The study identified organophosphates, aluminum phosphide (Selphos), Paraquat, Yellow Phosphorus, and household poisons as the most commonly encountered toxic agents. Oral ingestion was the most frequent route of exposure. Consistent with past studies by Sharma et al.^[9] and Banerjee et al.^[10], early hospitalization within two hours significantly improved survival rates, emphasizing the importance of prompt medical intervention and first aid measures. Although stomach wash administration was associated with better survival rates, it did not show a statistically significant impact on outcomes, suggesting that poison type and severity play a more crucial role in prognosis. A comparison of biochemical and hemodynamic parameters between survivors and non-survivors indicated significant differences in respiratory rate, SpO₂ levels, hemoglobin, total leukocyte count (TLC), total bilirubin, and SGOT levels, suggesting their role as potential prognostic markers. Patients who developed complications such as acute kidney injury (AKI), hepatic failure, and ventilator-associated pneumonia (VAP) had higher mortality rates, further highlighting the need for intensive monitoring and supportive care in high-risk cases, as reported by Bogale et al.^[11] and Majumder et al.^[12]

The study findings align with previous research emphasizing the impact of early intervention, poison type, and clinical complications on patient outcomes. Studies by Divekar et al.^[5] and Jaiswal et al.^[13] demonstrated that organophosphate poisoning is highly lethal, with symptoms such as nausea, vomiting, muscle spasms, and excessive salivation, often requiring ventilatory support. Aluminum phosphide poisoning had the highest fatality rate, particularly among those ingesting the more toxic, unexposed form, leading to severe cardiovascular complications, as supported by Patil et al.^[14] Paraquat poisoning resulted in multi-organ failure, with a lack of an effective antidote contributing to poor prognosis, a finding consistent with Mallows et al. ^[15]Yellow phosphorus poisoning was particularly lethal due to its hepatotoxic effects, necessitating intensive care and prolonged hospitalization, as highlighted by Balasubramanian et al.^[16] Household poisonings, including cleaning agents and medications, had better survival rates, reinforcing the need for public awareness and preventive measures such as safe storage and regulatory policies, a concern raised by Chatterjee et al.^[17] and Varghese et al.^[18] The study also highlighted the importance of psychiatric evaluation for all poisoning cases, as mental health issues played a significant role in suicidal poisoning, a factor previously noted by Ahuja et al.^[2]

The findings emphasize the critical need for strengthening public health interventions, including better regulation of toxic substances, early hospitalization protocols, and improved access to mental health care. Timely risk assessment, targeted management strategies, and enhanced emergency response systems are essential to reduce morbidity and mortality associated with poisoning cases, as evidenced in studies by Islam et al.^[19] and Bhadade et al.^[6]

Acute poisoning outcomes are significantly influenced by substance type, exposure duration, and timely medical intervention. This study highlights that early hospitalization within two hours significantly improves survival rates, reinforcing the 'golden hour' concept in poisoning management. Strengthening public health policies, regulating hazardous substance access, and increasing awareness among agricultural workers and the general population can help reduce poisoning cases. Additionally, integrating mental health support and poison information centers into healthcare systems is essential for effective prevention and management.

Conflict of Interest: The authors declare no conflict of interest.

Financial Support: No financial support or funding was received for this study.

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