INTRODUCTION Acute poisoning is one of the common presentations in Emergency and Trauma Department requiring specific management approach based upon patient's characteristics. Patients’ outcome are based on various factors
which includes types of poisons, amounts of poisons, level of toxicity and patient's pre-morbid status. Emergency and Trauma Department (ETD) toxicology cases compilation started from 1st October 2013 as databases for the purpose of management audit in poisoning cases.
OBJECTIVE The objective is to evaluate the patterns of acute poisoning cases in relation to their epidemiological data, types of poisons, types of venoms and patient's outcomes. This review is also used to further understand the demographic data of acute poisoning cases in Kuala Lumpur.
1 1 st EMAS MEETING 2016
METHODS A prospective study was conducted on poisoning cases attended at the ETD of Hospital Kuala Lumpur from 1st October 2013 until 31st March 2016. All cases of suspected or alleged ingestion of poison or drugs were included in this review. Descriptive analysis was carried out by looking at the types of poisoning, route of administration and patient outcome.
RESULTS A total of 708 cases labelled as poisoning which comprised of 64.4%
(456) cases due to toxic agents and
35.6%(252) due to venoms.In subgroup venomology; 19.8% (50) patients aged were less than 18 years old with 2.3%(6) of cases were less than 2 years old, 3.9%(10) of cases more than 60 years old. 73.4%(177) involved was Malay, 17.8%(43) Indian and 8.7%(21) Chinese. 72.6%(183) was male patients and 27.3%(69) female. Types of venoms included bite cases 54.3%(137) and 45.6%(115) due to sting. In the sting category;43.6%(110) were due bee stings, others were benign insect bites.
11.9%(30) snake bite reported. No mortality reported was in this subgroup.
For subgroup toxicology;
78.4%(357) patients aged between 18 to 60 years old, 9%(41) age between 5 to 18 years old.45.4%(184) cases were lndians, and 38.5%(156) Malays.61.8%(282) were female patients.93.2%(425) of cases used oral administration followed by inhalation, which comprises of 6.3%(29). Toxic agents used were paracetamol
17.5%(80) cases, Clorox 13.8%(63) and cyanide inhalation, 22 cases. Accident ingestion was the most common cause of toxicology with 35%(160) cases, deliberate self-harm
25.4%(116) cases are suicidal with
M-JEM Supplementary 1 (2016)
23.9%(109) cases. N-Acetyl-cysteine was the most commonly used antidote
47.7%(21) cases followed by atropine
15.9%(7) cases and Ophanedrine 9%(4) cases. 5 reported deaths were in this subgroup.
Venomology Patients mostly are within the productive age of 18 years to 60 years old corresponds to studies from Chew et al(2011) and Cesaretli Y el (2010).1,2 and similar to the national statistics. Most of them presented to the hospital during the afternoon shift, 38.4%, corresponding to the norm of workload in emergency department. Jamaiah et al (2006) also reported highest snake bite incidence during the afternoon shift too (2pm to 9pm). This happens most likely because people are still at work and being out in the working field. Majority cases are bee sting (43.6%) and insect bite (39.2 %). In 2014, American Association of Poison Control (AAPC) centers reported 3968 cases of bee, wasp, or hornet stings, while other insect bites were 6049 cases. These two categories remain the top two cases among envenomation in Malaysia and America.
Toxicology Most of the patients were between 18 to 60 years old, comprising of 78.4% (351). Database from the American Medical Association (AMA) 2006 also reported the similar findings with 91.9% were aged between 18 to 54 years old and majority were of them were male with 67.1% among the unintentional pharmaceutical overdose fatalities. Regarding the route of administration, oral administration was the most with 93.2%(425) compared to inhalational with 6.3%(29). The data from the "2014 Annual Report of the AAPCC" also recorded that ingestion was the highest cases reported with 83.7% followed by dermal (7.0%) and inhalation (6.1%). The top substance reported in this review was paracetamol at 17.5% (80).
Conclusion This review showed that the disease burden of acute poisoning cases in Kuala Lumpur City is enormous and it also contributed to our preparedness in managing such cases.