Pattern of Chemical Poisoning, Riyadh 1999-2001

Acute chemical poisoning is the third most common cause of deaths in the home.[1] The medical costs of poisoning treatment can be substantial, exerting considerable burden on the national health care service in both developed and developing countries. Due to the absence of regional poisoning control centers and standardized reporting methods, data on the epidemiology of poisoning in Saudi Arabia are not available and few studies have been conducted to explore this problem locally. This study aims to describe the pattern of chemical poisoning in Riyadh region during a three year period (January 1999-December 2001), and to highlight some demographic associates.

This cross-sectional study was performed by analysis of data extracted from registers of all recorded cases of chemical poisoning (drugs and chemicals) reported to Directorate of Health Affairs, Riyadh, Ministry of Health, from all Riyadh hospitals during the study period. Cases of food and animal poisoning were excluded. Cases of Chemical poisoning were defined as all cases that had resulted from ingestion of (or contact with) substances that can produce toxic effects; including exposure to drugs, chemicals, or any environmental substance. Environmental substances include: household items, cleaning substances, insecticides, pesticides, rodenticides, solvents, cosmetics, fuels, and carbon monoxide and other toxic gases.

A data collection form containing demographic characteristics e.g. age, gender, nationality, occupation, type and name of poisonous substance, time, route and circumstances of exposure, management and outcome, was completed. Data were checked for completeness and consistency by matching a random sample of the reprints in the Directorate of Health with that of affiliated hospitals. Most cases of chemical poisoning occurred in children under five years of age (Table 1), followed by the 5-11 year age group. Males (56%) predominated females (44%) (ratio 1.3:1.0). Children under five constituted 74.8% of males and 56.3% of females. The majority of studied cases were Saudis (93%). Cause of poisoning was accidental in 83.7%, intentional in 12.4%, and unknown in 4%. A high percentage of intentional poisoning (70%) occurred in individuals under 30 years of age, most of who were females (74.3%).

A single substance was implicated in 94% of cases and 6% had been exposed to two substances or more. The most common mode of toxin ingestion was orally (91.6%), and most occurred due to pharmaceutical products (67.2%), followed by antiseptics (11.3%). Paracetamol was the most common cause of poisoning (9.8%) followed by antihistamines (9.1%). 35% of poisoning cases reported symptoms; 30.4% within one hour of exposure. 50% of symptomatic cases presented with vomiting, 26% were drowsy, 18% had difficulty in breathing, and 2.5% had convulsions. Most cases (62.5%) sought treatment within one hour of the poisoning episode. Most cases were reported on the same day (81.8%), or on the second day in 12.8%. Most (94.6%) arrived to hospital in a stable condition, 5% detoriated, and 0.4% arrived dead. Regarding management, 56.8% received treatment and were discharged from the ER, 37.2% were admitted into hospital and 6.1% were discharged against medical advice. Most cases recovered completely (92.7%). The mortality was 1%.

Chemical poisoning remains hugely underestimated in some developing countries,[2] where poisoning by pesticides and household products, as well as overdose with pharmaceuticals are extremely frequent especially among children.[2,3]

A study of cases of accidental poisoning among children admitted to all Riyadh Governmental Hospitals, Saudi Arabia, during a five year period (1983-1987) showed that household products were the most common poisoning agent, accounting for 59% of all cases. Fatality rate was 0.1%. [4]

The findings of the present study are in agreement with findings worldwide.[1,2] Pharmaceutical products contributed to most cases of poisoning, which may be due to dispensing of drugs in envelopes instead of child-resistant containers, free medical treatment and easy access to drugs.

Unlike other developing countries where household products represent the most frequent cause of poisoning,[5] in Riyadh, Pharmaceutical products constituted a greater problem. In a previous study, Pharmaceutical products accounted for 53% of cases of accidental home poisoning and household products for 46%.[6]

Health education for parents and caregivers of young children is recommended. Child resistant containers should be used for packing drugs instead of envelopes to avoid drug-related poisonings. Regional poisoning control centers should be initiated and enforced. Their role in prevention is also imperative through planning, research, and education.