Forensic Science International, 36 (1988) 101-104 Elsevier Scientific Publishers Ireland Ltd.

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PATTERN OF ACUTE POISONING IN A MEDICAL UNIT IN CENTRAL SRI LANKA

NIMAL SENANAYAKE and LAKSHMAN KARALLIEDDE*

Faculty of Medicine, University of Peradeniya, Peradeniya (Sri Lanka)

Summary

One hundred and seventy nine cases of acute poisoning constituting 1.1% of all admissions to the medical unit over 3 years were analysed. Eighty-three per cent of the patients were under 30 years of age and 72% were males. The common agents were: OP insecticides in 51%, kerosene oil in 12%, rat poison in 0% and drugs in 8%. Ingestion with suicidal intent was the common mode of poisoning. The overall mortality was 16%. The results from four other major centres in Sri Lanka are presented for comparison.

Key words: Acute poisoning; Sri Lanka

Introduction

The pattern of poisoning within a country depends on a variety of factors such as the availability of various poisons, socio-economic status of the popu- lace, religious and cultural influences and the prescribing pattern of drugs.

The first report of poisoning in Sri Lanka was in 1853 [ 11. Early literature is virtually limited to descriptions of poisoning by arsenic [ 11, carbolic acid [ 21 and opium [3]. Plants as poisonous agents in Sri Lanka were medically dis- cussed 1915 [4]. Later much attention was drawn to poisoning following Mani- hot utilissima (Maniac) [5] and G2oriosa superba (Niyangala) [6]. The first report of poisoning due to a prescribed drug was in 1955 [7]. A year earlier the first proven case of insecticide poisoning was reported [8].

This paper reports the experience of the authors in the management of acute poisoning at the University Medical Unit in central Sri Lanka. Reports from the north [9], south [lo], west [ 111 and central [ 121 Sri Lanka are presented for comparison.

Methods

Case records of all patients suspected of having been exposed to a poison requiring admission to the University Medical Unit at Peradeniya over a 2-year period ending 31st December, 1985, were analysed.

*To whom correspondence should be addressed.

0379-0738/&3/$03.50 G 1988 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland

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TABLE 1

AGE AND SEX DISTRIBUTION OF THE 179 PATIENTS

Age (years) Male Female Total

115 4 3 7 (4%) l&l9 35 17 52 (29%) 20-29 71 25 96 (54%) 30-49 15 3 18 (10%)

>50 5 _ 5 (3%) Not known 1 _ 1

Results

Over the 2-year period, 179 cases of acute poisoning, constituting 1.1% of all admissions to the medical unit had been seen. The age and sex distribution of these patients is shown in Table 1. Table 2 shows the agents responsible. The drugs encountered were chiefly phenothiazines, chlorpromazine in particular. Phenobarbitone was taken by one, diazepam by another and aspirin by two. The miscellaneous agents ranged from chemicals such as copper sulphate, zinc oxide and phenol to chloroxylenol (Dettol), and the tuber of G. superba and arsenic. Self-poisoning with suicidal intent was evident in all cases of inges- tion except in five instances where accidental poisoning was suggested. One patient with organophosphorus (OP) poisoning developed the symptoms after spraying the insecticide.

Ninety per cent of the patients came into hospital within 3 h of poisoning. Eighty per cent of admissions were between 18.00 and 02.00 h, when only emer- gency services are available in the hospital service of Sri Lanka. Alcohol consumption at the time of poisoning was evident in 14 (8%) males who in- gested OP insecticides. Associated conditions encountered were psychiatric disease in four, cardiac disease in three, diabetes mellitus in one and preg- nancy in two. All patients with psychiatric disease presented with poison- ing of prescribed drugs. The clinical features of poisoning and treatment

TABLE 2

AGENTS RESPONSIBLE FOR POISONING

No. %

OP insecticide 92 51 Kerosene oil 21 12 Rat poison (Zn) 15 8 Drugs 14 8 Paraquat 10 6 Miscellaneous 19 11 Unknown 8 4

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TABLE 3

ACUTE POISONING IN CENTRAL, WESTERN, SOUTHERN AND NORTHERN SRI LANKA

Figures expressed as percentage

District Pesticides Drugs Kerosene Others Self Accidental Mortality oil poisoning

24

1. Central 65 8 12 15 97 3 16 (Peradeniya 1984/85, n = 179)

2. Central 51 9 7 23 82 18 (Kandy 1970171, n = 472)

3. Western 46 25 9 20 80 17 (Colombo 1976, n = 130)

4. Southern 52 17 ? ? 81 14 (Galle 1983, n=lOO)

5. Northern 65 17 _ 18 68 32 7 (Jaffna 1983, n = 446)

5

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varied with the type of poison. The overall mortality was 29 (16%) the agents responsible being OP insecticides in 17, paraquat in 10 and G. superba in two. The mortality associated with paraquat poisoning in our patients was 100%. There was no mortality associated with drug poisoning. Results from centres in north, south, west and central Sri Lanka are given in Table 3 for comparison.

Discussion

The pattern of poisoning in Sri Lanka differs strikingly from that in devel- oped western countries in that pesticides are responsible for the majority of cases. The incidence of poisoning due to drugs was highest in the capital city, Colombo (25%) and lowest in the predominantly agricultural central Sri Lanka (3%). The second striking feature is the very high incidence of poison- ing in the young age groups. In this study, 83% of the patients were between 10 and 30 years of age. In Colombo, 66% of the patients were below 30 years of age and in Jaffna, 74% were between the ages 11 and 30 years. Only 6.2% of the 472 patients from Kandy were over the age of 50 years, very similar to our observations (3%) and those from Jaffna (5%). These findings are in contrast to the observations from the developed countries [ 131.

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The male preponderance (M/F ratio 3 : 1) in our study has also been ob- served by other workers in Sri Lanka. This too is in contrast with the ratio of 1 : 2 reported from the west [ 141. Self-poisoning with suicidal intent far exceeds accidental poisoning. The use of pesticides and drugs for homicidal purposes is very rare in Sri Lanka. Another interesting observation in our study was that kerosene oil is used as a poison, predominantly by females.

The incidence of medical disease amongst patients with poisoning was low. Furthermore, the low incidence of poisoning in those over the age of 50 years indicates that incurable disease, loneliness and other factors associated with old age are not common causes for attempted suicide in Sri Lanka. The greater incidence amongst young males suggests that factors related to employment and economic factors may be important in poisoning in Sri Lanka.

References

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