Indian 07, Pediat. 41: 174, 1974

ACCIDENTAL POISONING IN CHILDREN IN JAIPUR (RAJASTHAN)* USHA SHARMA AND S. SAXENA

yaipur

Innumerable deaths in children due to accidental poisoning occur all the world over which is of serious concern since the lives of these toddlers can be saved in most cases by correct guidance to the parents, suitable propaganda and modification of local habits and environ- mental conditions. As the age advances, morta l i ty rate due to infections is de- clining on account of bet ter living standards, education, immunisation etc.,

while that due to poisoning is increasing tremendously. It will not be an exaggeration to say that it has

become a leading heal th problem at least in foreign countries where other diseases have been successfully con- trolled. In this country too, al though infectious diseases, malnutr i t ion etc. are prevalant and mask the poisoning cases yet the lat ter poses a frequent problem as is apparent from statistical data.

The incidence of poisoning reports

from various parts of the country has been variable, depending upon the environment, living conditions, habits and socioeconomic status of the patient. This is apparent from several reports published from time to time from dif- ferent parts of the country (Arora 1953, Pohowalla and Ghai 1959, Mukherji and

* From the Department of Paediatrics S.M.S. Medical College and Hospitals, Jaipur. Received on February 23, 1974.

Sur 1959, Manchanda and Sood 1960, Kha t r i et al. 1968, Santhana Kr i shnan

et al. 1972 and Talat i and Gandhi , 1973). Although Lall etal. (1970) have reported acute isoniazide intoxication from this state, no study pertaining to general analysis of chi ldhood poisoning has been published so far.

In view of the paucity of reports from Rajasthan and possible regional differences, it was considered worth- while to analyse the cases of accidental poisoning admit ted to the medical pediatric unit of S.M.S. Hospital,

Jaipur, to ascertain the pat tern of commonly encountered poisoning and

suggest control measures to minimise such catastroptfies.

Material and Method

All the cases of various types of

poisoning admit ted to the paediatric unit, S.M.S. Hospital, Jaipur, from January 1973 to June, 1973 have been included in this study.

O b s e r v a t i o n s

There were 1568 total admissions to the paediatr ic depar tment fl'om

January, 1973 to June, 1973, out of which accidental poisoning accounted for 80 cases (5.1%). The corresponding figures quoted by other workers vary from 0.8% to 2.3% (Talat i et al. 1973) the highest figure of 7.6% having been quoted by Buhar~walla and Sanjanwalla

SHARMA AND SAXENA~ACCIDENTAL POISONING IN CHILDREN IN JAIPUR (RAJASTHAN) 175

(1969). It is worth emphasizing here that the real incidence of poisoning is difficult to assess, as the asymptomatic

cases and those having trivial symptoms

are usually not brought to hospital and

hence the figures are likely to be modified if those cases are included.

Age incidence Children between 1-3 years were

most prone to poisoning accounting for

58.75% of the total. The one-year- age group was responsible for 20% cases,

3-5 years (12 5%), 5-7 years (5%) and 8-12 years (3.7%) as shown in Table 1.

Sex incidence The study included 35 (68.7%) male

and 25 (31.2%) female children. These figures are similar to those of other Indian authors.

The various causes of accidental poisoning along with the percentage of the cases affected are given below:

Cause Percentage

Kerosene oil 55.0

Medicinal agents 27.5

Copper sulphate 6.2

Seeds 6.2

Caustic soda 3.7

Naphthalene 2.5

Rodenticide 2.5

Flit 1.2

Tik-20 1.2

Household poisons The poisons were divided into

three groups: household substances, medicaments and seeds. Household poisoning accounted for 57 (73.7%) of the total cases. Out of these kerosene oil was the main incriminating agent and responsible for 55% of the cases. Other common household products involved in accidental poisoning were naphthalene (2.5%), Flit (1.2%), roden- ticide (2.5%), copper sulphate (6.2%) Tick-20 (1.2%) and caustic soda (3.7%). Medical agents

There were 18 (27.5%) cases of poisoning due to ingestion of drugs out of which (8.7%) were caused by exces- sive dosage of opium, 2 cases each from drugs like Thrombhophobe, Lomotil, tincture of iodine and other unknown drugs. Atropine, Calmpose, Tofranil and Aspirin were responsible for 1 case

each.

Seeds There were 5 (6.2%) cases. Three

children had ingested Ratan fiat while 2 swallowed Dhatura seeds.

Symptomatology The signs and symptoms caused by

most of the poisons are relatively non- specific and physical examination seldom offers any definitive clue to the nature

of the incriminating agent. As there were 44 cases of kerosene oil poisoning in the series, accounting for the majority, an attempt is made to list the cardinal symptoms produced in these cases.

Table 1. The age incidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0-1 year 1-3 years 3-5 years 5-7 years 8-12 years Total

No. of cases 16 47 10 4 3 60 Percentage 20 58.7 12.5 5 3.7

176 INDIAN JOURNAL OF PEDIATI~ICS VoL. 41, No. 316

T a b l e 2. Symptoms at the time of admission.

Gastrointestinal Vomi t ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Abdominal pain . . . . . . . . . . . . . . . . . . . . . 6

Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Distension of abdomen .... . . . . . . . . 6

Respiratory Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Abnormal lung

findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Dyspnoea . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Restlessness . . . . . . . . . . . . . . . . . . . . . . . . 24

aVeroous system Purposeless movements ... . . . . . . . . . 4

Drowsiness . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Unconsciousness . . . . . . . . . . . . . . . . . . . . . 6

Dilated pupil . . . . . . . . . . . . . . . . . . . . . . . . 16

Convulsions . . . . . . . . . . . . . . . . . . . . . . . . 2

Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Sweating . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Frothing at mouth . . . . . . . . . . . . . . . 11

C.H.F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Twitching of face . . . . . . . . . . . . . . . . . . 5

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Tremors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

D i s c u s s i o n

For the past few years there has

been an appreciable increase in cases of childhood poisoning. Graig (1955) pointed out that a large group of children shows an exaggerated oral tendency and poison themselves indis-

crlminately with substances of any kind.

This may be partly due to easy access

by toddlers to the incriminating agent

but socioeconomic factors, environment and ignorance of the parents play a significant role in the mortality from poisoning.

The causes of poisoning vary in different countries and between rural and urban populations and are mainly governed by local customs, the level of education of the parents and other factors mentioned above. In the present study of 80 cases of various types of

poisoning, kerosene oil accounts for the maximum number, (55~ a figure in concordance with those of others (Santhana Krishnan and Raju 1972 Talati and Gandhi 1973) but corre--

pondlng figures from the Westeia literature are much lower. Other figures from the Indian literature are

30%, (Arora 1953), 30.8% (Pohowalla,

and Ghai 1959), and 9%(Jacobziner and Raybin 1956). Such differences may be explained by the environmental or socioeconomic habits of the inhabitants.

Next in frequency was poisoning from medicinal agents, the incidence of which was 27.5% in this study, a relatively higher figure compared to

that of Talati and Gandhi (1973) but almost similar to Arora's (1953;) Pohowalla and Ghai (1959) and

Santhana Krishnan and Raju (1972). Jacobziner and Raybin (1956) have recorded 43%.

Among this group opium was the main incriminating agent. The newer

insecticides have been minimally

responsible for poisoning in children as has been brought out in other studies. Aspirin and barbiturates though show- ing an increased frequency in western countries have been scarcely responsible

SARMA AND SAXENA--ACGIDENTAL POISONING IN CHILDREN (RAJASTHAN) 177

for childhood poisoning in this study. A very high incidence of these poisons has been quoted by Arora (1953), Poho- wal laand Ghai (1959) and Mukherjee (1959) which may be due to local factors in those areas, the children probably having easy access to the seeds; however our findings are in accordance with those of Manchanda and Sood (1960).

Signs and symptoms caused by most of the poisons are relatively non- specific and the physical examination seldom offers a definitive clue to the nature of the poison. However, in kerosene oil poisoning vomiting was encountered in (30%) cases in contrast to 74% reported by Steiner (1947), 27.5% by McNally (1956), 51.4% by Mukherjee and Sur (1959) and 40% by Ghose and Agarwal (1962). Fever was present in 33.7% in this series indicating a fre- quently encountered complication and corroborates with the figures quoted in the series by McNally, 1956.

Management The general treatment consists of

gastric lavage as and when indicated. Activated charcoal may be given to inhibit the gastrointestinal absorption within 30 minutes after the poison has been ingested. I.V. fluids and diuretics should be administered to increase the urinary flow and excretion of the poisonous substances. Peritoneal dialysis can be resorted to where indicat- ed. I f a specific antiodote is available, it should be given without delay.

Specific treatment depends upon the incriminating agent and should be

instituted accordingly.

Prevention

Many children lose their lives every year all over the world from accidental poisoning which can be successfully prevented in most of the cases by correct guidance to the parents, Advice to the parents should include information on nonedible articles

being kept away from foodstuff and out of the reach of children. The sub- stances should be kept in their original containers with proper labels. No medicaments should be given to the children in the dark without proper reading of the labels and contents. Unwanted articles should be removed from the household dumps. Iatrogenic poisoning can be prevented by doctors and nursing staff. The injudicious use of drugs and medicines should be dis- couraged.

A dynamic and comprehensive control programme should be chalked out to deal with such a community problem with special emphasis upon health education.

Summary I. The study includes data of 80 cases

of chemical poisoning in children under 12 years ofa~e.

9. 78.7% of all the poisonings occurred between 0-3 years, of which the maximum incidence (59.7%) was encountered between 1-3 years.

3. Males were predominantly affected.

4. Household substances were respon- sible for the maximum number of cases (73.7%) in which kerosene oil was the chief offender (55%).

178 INDIAN JOURNAL OF PEDIATRICS

R e f e r e n c e s

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Buhariwalla, R.J. and Sanjanwallm (1969). Poisoning in children (A study of 303 Cases). Indian Pediat. 6, 141.

Craig, T.O, (1955). Oral factors in accidental poisoning Arch. Dis. Child, 30, 419.

Ghose, $. and Agarwal, V.P. (1962). Accio d~ental poisoning in childhood 97. Indian Med. Assoc. 30, 637.

Jacobziner, H. and Raybin, H.W. (1956) Accidental poisoning in childhood and their prevention ft. Pediat 40, 592.

LalI, K.B., Saxena, S. and Mehta, J.B. (1970). Acute isoniazide intoxication Indian. Pediat. 7, 231.

Manchanda,S.S. and Sood, S,C. (1960). Accidental poisoning in children Indian ft.

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Pohowalla, J.N. and Ghai, O.P. (1959). Poisoning in children, indian 97. Chld. Hlth. 8 205,

Santhana Krishnan, B.R. and Balgopala Raju. V (1971). Poisoning in childhood Indian J . Pediat. 39, 158.

Steiner, M.M. (1947). Syndromes of kerosene oisoning In children, Amer. 97. Dis. Chldh. 74, 32.

Tatati, S.C. and Gandhi, V,K. (1973). Accidental poisoning in children with special reference to kerosene poisoning. Pediat. Clin India, 8, 65 .