Date of Award

Winter 1-4-2019

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Shubha Seshadri

Second Advisor

Dr. Sneha Seshadri

Abstract

INTRODUCTION: Rodenticide consumption is a very common form of poisoning, either accidental or intentional, and is mainly reported in the rural parts of India. Rodenticides generally comprise of Superwarfarins, Thallium, Barium Carbonate, Aluminium phosphide (AIP) and Zinc phosphide. They are quite inexpensive and highly toxic chemicals. Annually, around 50,000 cases are reported [1]. The agents present in rodenticides are hepatotoxic in nature and the outcome is often fatal. Therefore, it has always been a concern in major public health, especially in Asian countries. Absence of a definite antidote often results in high mortality rate among the patients. Recent studies suggest the positive role of N-Acetyl Cysteine (NAC) treatment in Rodenticide poisoning. OBJECTIVES: The present study was planned with the objective to understand the general treatment pattern and the effectiveness of N-Acetyl Cysteine in Rodenticide Poisoning. METHODOLOGY: A retrospective study was performed at Kasturba Hospital (a tertiary care hospital) on Rodenticide poisoning patients admitted during the period 2012- 2017. Details of patients including demographics, severity of poisoning, biochemical parameters, general treatment pattern, dose, duration and route of N-Acetyl Cysteine (NAC) treatment given along with the outcome were collected in the case report form. The results were analyzed using SPSS 20.0.RESULTS: A total of 229 patients were enrolled in the study with the mean age being 30.04 ± 15.67 years (Mean ± SD). There was no significant variation seen in gender-wise distribution among the study population. The mean hospitalization period was found to be 7.08 ± 5.48 days. Risk factors associated with mortality were analyzed. Yellow Phosphorus poisoning and Time lag greater than 24 hours from the ingestion of poison to the initiation of treatment were found to be significant among patients. Psychiatric illness was present in 17.7% of the patients which precipitates as a major risk factor for the Intentional Self Harm. Among general treatment approaches used for rodenticide poisonings, Activated Charcoal had significant effect on the outcome (94.8% versus 81.05%) with p ≤ 0.035. There was no significant association of Gastric Lavage (89.7% versus 80.7%) and Vitamin K (80.91% versus 86.73%) with outcome. Outcome analysis with NAC showed that patients who received NAC had significant improvement [84.9 % (with NAC) versus 64.7 % (without NAC)] in survival with p ≤ 0.031. The mean oral STAT dose and Maintenance dose was 7580.95 ± 2204.29 mg and 3694.53 ± 2322.58 mg respectively. The mean dose for 21- hour IV regimen of NAC given over 1 hour, 4 hours and 16 hours was found to be 7975.65 ± 2356.63 mg, 2913.79 ± 1580.85 mg and 5445.95 ± 1867.21 mg respectively. CONCLUSION: The study was conducted in a tertiary care hospital to understand the general treatment pattern and to evaluate its appropriateness. Among all the Rodenticide Poisoning cases included in the study, majority were due to Intentional Self Harm. Yellow Phosphorus poisoning and Time lag greater than 24 hours from the ingestion of poison to the initiation of treatment are found to be significant Risk factors among patients. Presence of Psychiatric Illness can also contribute the suicidal tendencies. Treatment versus Outcome Analysis showed significance with NAC and Activated charcoal. However, recovery rate was found to be better with Gastric Lavage and administration of both Gastric lavage and Activated Charcoal. Outcome analysis with respect to IV NAC has shown recovery rate to be better in those patients who were treated with 21 hour regimen.

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