Drug and Chemical Poisoning in Northern Iran
A.R. Sobhani DVM, H. Shojaii-Tehrani MD, PhD, E. Nikpour MD, N. Noroozi-Rad MD
Department of Pharmacology, Gilan University of Medical Sciences, Rasht, Iran
Background
and Objectives-Poisoning
due to drugs and chemicals is influenced to a large
extent by the population’s socioeconomic and
cultural status. The purpose of our study was to
determine and present the pattern of poisoning with drugs
and chemicals in 2 poisoning referral centers in Gilan
province, northern Iran, and to analyze medical and
social parameters involved.
Methods-This retrospective
cross-sectional study was performed on 1215 cases of
poisoning (with drugs and chemicals) who were
hospitalized in 2 poisoning referral centers, namely,
Razi and 17-Shahrivar Hospitals in Rasht during a
three-year period. Chi-square and a values were considered for the
statistical analysis.
Results-Five-hundred and twenty-six of
the poisoning cases (25%) were children and 1625 cases
(75%) were adults. Poisoning was most common in the 15-64
years age group and in women. In order of frequency, the
three most common causes of poisoning in adults were
organophosphorous compounds, rat-killers, tranquilizers
and anticonvulsants, and in children they were kerosene
oil, detergents, and metoclopramide. The fatality rate
was 1-4%. A significant statistical relationship
(p<0.05) was noted between the type of poison and
patient’s age, sex, occupation, residence
(village/city), cause of poisoning (intentional/
accidental) and season in which the poisoning occurred.
Conclusion-It was seen that women between
15-64 years of age were more prone to suicidal poisoning
with organophosphorous compounds in spring and summer and
children of 1-4 years of age were more susceptible to
accidental poisoning with kerosene oil and its
derivatives in the spring. The fatality rate of this
study was higher as compared to other cities in Iran and
other industrialized countries. It is thus recommended
that more preventive measures be taught to the general
population.
Keywords · Drug toxicity · drug poisoning · chemical poisoning
Introduction
Poison is a substance capable of producing damage or dysfunction in the body by its chemical activity. It can enter the body in various ways to produce general or local effects (limited to the eyes, skin, lungs, etc.). All cases of poisoning that result from accidental use of drugs and chemical substances, or the use of drugs by children due to curiosity, are known as accidental or non-intentional poisoning. Poisoning is a qualitative term used to define the potential of a chemical substance in acting adversely or deleteriously on the body.1
Advances in technology and social development have resulted in the availability of most drugs and chemical substances in the community. These chemical substances pose a significant threat due to the extensive use in medicine, agriculture, industry and residential environments.5
In 1995, drugs were found to be the third most common cause of poisoning that lead to death in the USA. Poisoning from drugs was the main cause of death in the 35-44 years age group. During 1990-95 mortality rate due to poisoning showed a 25% rise.2 Fifty-nine percent of the poisoning occurred in the under 14 years age group.3 The prevalence of hospitalization and death was highest among the elderly.4
On the whole the most common drugs that cause poisoning were tranquilizers and antipsychotics, especially benzodiazepines, phenothiazines and tricyclic antidepressants.3
Drugs are among the major causes of acute poisoning in both cities and villages. Studies conducted in different parts of Iran including Tehran5, Mashhad6 and Babol7, all point to the high prevalence of poisoning due to drugs and chemicals. The main causes of this type of poisoning differ in various areas of Iran. In Tehran5, Mashhad6, and Babol7, for example, tranquilizers (diazepam) have been found to be the most common causes of drug-related poisoning. Fertilizers and pesticides are widely used in Gilan, northern Iran, and that explains why the majority of poisoning cases are due to these substances in this region.7
The pattern and cause of poisoning is influenced by socio-economic and cultural factors as well as the religious beliefs prevalent in the community. A considerable number of suicidal cases have been observed in the last few years in Rasht (which is also a northern city of Iran).
The aim of this study is to investigate the pattern of drug and chemical poisoning in both adults and children in northern Iran.
Materials and Methods
This cross-sectional study was carried out by data collection from the medical records of patients who had attended the two poisoning referral centers, covering Rasht and its neighboring cities during a three-year period between 1995 and 1997. The population under study were the patients hospitalized during a three-year period.
The variables in these records included age, sex, occupation, type of poisoning, poisonous substance used, season of its occurrence and the condition of the patient at the time of dismissal. Data were expressed as mean and differences between means were considered statistically significant if p<0.05.
Results
During the 3-year period of our study, a total of 1625 adults and 526 children (under 12 years of age) had attended the two poisoning referral centers in Rasht. Among the adults, 835 (51.4%) were female and 790 (48.6%) were male and among the children 235 (44.7%) were girls and 291 (55.3%) were boys. We observed that women in the 15-64 years age group and 1-4-year-old boys suffered more from poisoning than the other groups.
Organophosphorous compounds and opiates are major killers in adults and children, respectively (Table 1). Poisoning with opium compounds and sedatives, alcohol, and organophosphorous compounds proved to be most common among business people, the unemployed, and farmers respectively. Poisoning was also more common among housewives than working women. It was also seen that 1572 (66.5%) of the cases came from cities and the remaining from rural areas. Among the adult poisoning cases, 1150 (70.8%) and among the children poisoning cases, 377 (71.7%) occurred in cities (and the rest in villages). Intentional poisoning was seen in 1372 (78.3%) adults and 9 (1.7%) children.
It was observed that intentional poisoning is more frequent in males and non-intentional poisoning occurs more in females. Intentional poisoning was also significantly more (p<0.05) in the cities and non-intentional poisoning was more common in villages.
The mortality rate was seen to be higher in men (p<0.05). Drug-related poisoning was responsible for 1.4% of deaths on the whole (1.7% in adults and 0.6% in children). Three death occurred in children which had resulted from unintentional poisoning with kerosene oil (1 case), organophosphorous (1 case), and metoclopramide (1 case).
A significant relationship (p<0.05) exists between the poisonous substance and the season in which poisoning occurred. It was seen that poisoning in children occurred mostly during spring , while in adults was more frequent during spring as well as summer seasons. Poisoning due to organophosphorous compounds, detergents and kerosene oil derivatives were also more frequent in the spring and summer seasons.
Discussion
In this study, most of children poisoning occurred in the 1-4 years age group. Similar findings were seen in a study conducted in Loghman Hospital (Tehran).8 A study conducted on fatal poisoning cases in Tehran showed an overall male to female ratio of 1.9: 1 with females predominately in the 13-19 years age group.9 In another study, which was carried out in the USA the 1.5-3 years age group was seen to be more at risk of children poisoning.10 About 24.5% of the poisoning cases were seen in children under 12 years of age and 75.5% occurred in adults. Studies conducted in Babol, have shown that 22% of acute drug poisoning occurred in the under-15 years of age group and the remaining occurred in the older ages.7 In a report on a study conducted in the USA, it was seen that 72.4% of the total cases of poisoning occurred in under-five years of age and 12.6% in the 5-12 years age group (totally 85%) and the remaining 15% occurred in adults.10 The similarity of our results with those conducted in Babol, most probably relate to the geographical, agricultural and cultural similarities of these regions as opposed to those prevalent in the USA.
Our study revealed that the majority of poisoning case occurred in women between the ages of 15-64 years, of which 61.9% were intentional. These results correspond to those reported from Loghman Hospital13 in Tehran as well as Imam Reza Hospital in Mashhad9 and the forensic report from Tabriz.14
Our study further revealed that the major risk of poisoning occurred in children younger than 4 years, which is similar to the findings of the study conducted in Loghman Hospital in Tehran.8
It is noteworthy that 78.3% of adult poisoning case in our study were intentional which corresponds well to the figure of 76.9% reported from Loghman Hospital in 1996.
These results are in sharp contrast to those reported from the USA where almost 90% of cases of poisoning were accidental. The high rates of intentional poisoning in the Iranian studies may reflect increasing social, economical and psycho-logical pressures in the past few years.
Our study indicate that the most common cause of poisoning amongst children has been accidental ingestion of kerosene especially during the spring season, which has also been corroborated by studies conducted in Tehran8, Tabriz16 and Rasht17, whereas it seems that in the USA, the most common cause of accidental poisoning in children are aspirin and other analgesic medications.3
It also became apparent that accidental poisoning in adults in northern Iran was mainly caused by organophosphorous compounds during the spring and summer seasons and is due to the abundant use of these compounds as pesticides by opiates was the second most common cause.
The overall mortality in our study was 1.04% and the major cause of death was opiate compounds. A similar study conducted in Loghman Hospital (Tehran) in 1996 showed that, of 16,531 cases of poisoning, the overall mortality was 1.08% and the major causes of death were opiates, fertilizers and detergents.11
In contrast American studies have shown a 1% mortality rate with antidepressants and analgesics as the main causative agents.
In conclusion, our study showed that the major causes of accidental poisoning in Rasht were organophosphorous compounds in adults and kerosene oil in children.
To prevent such accidents, it is recommended that wide-spread community education should be implemented to increase popular awareness of the danger of these compounds and to stress to parents to keep chemicals and medications out of reach of young children.
A significant relationship was also noted between the type of poisoning and patient’s occupation. Poisoning was more common with opiates and tranquilizers in employed workers, with alcohol in the unemployed and organophosphorous com-pounds in farmers.
References