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Letters to the Editor

Indian Pediatrics 2002; 39: 102-104  

Seasonal Pattern of Pediatric Poisoning in an Agricultural Belt of West Bengal


Tamluk is an important subdivision of West Bengal, with total population of 20 lakhs 74 thousand out of which about 19 lakhs are rural population engaged in rice and betel leaf cultivation round the year. ‘Boro Cultivation’ is the high yield rice cultivation, done during winter months, when, due to fog and cloud, attacks of pests and fungus are common. To combat this problem large amount of pesticides and fungicides are accumulated in the farmer’s houses leading to frequent pediatric poisoning during this time. Hydrocarbon and other toxic plant poisoning occur throughout the year. The admission pattern due to these poisonings in the subdivisional hospital in the first three months (Jan-Mar, 2000) was 50 out of 200 and in the subsequent months (April-Dec, 2000) 90 out of 1596 admitted cases (p <0.05). Out of the above 50 cases 38 (76%) were due to insecticide and fungicides, 10 (20%) due to kerosene and 1 (2%) each due to napthalene and yellow oleander poisoning. Insecticide and fungicide poisoning were significantly common in comparison to other poisonings (p <0.05). One study from an urban area of North India showed 10% poisoning due to organophosphate compounds (OPC)(1), whereas in our rural agricultural belt OPC poisoning was 50%. Age and sex distribution of these cases revealed that toddlers were commonly affected (mean age 2.73 yrs; SD 1.66 yrs) and males outnumbered females significantly (p <0.05) (Table I). Number of admitted cases due to insecticide and fungicide poisoning were –26(<3 yrs), 11 (3-6 yrs), 1 (7-10 yrs), due to kerosene poisoning were 8 (<3 yr), 2(3 to 6 yrs), nil (7 to 10 yr), napthalene poisoning 1 case (<3yr), and yellow oleander poisoning 1 case (7 to 10 yrs). Thus, the age group most affected by poisoning was below 3 years. All cases were accidental except one (adolescent step brother poisoned a 12 months old). No history of poison ingestion was available in 50% of the cases. These cases (about 50%) were referred to hospital as respiratory tract infection, bronchopneumonia, seizure disorder and acute gastroenteritis by primary physicians. Slight exposure to OPCs were highly dangerous in most cases (one child chewed a piece of insecticide smeared cloth, this history was available later). OPC poisoning cases pre-sented clinically with more severe symptoms than carbamate poisoning. Organophosphate insecticide [Metacid-Methyl Parathion 50%, Bayer] and OPC fungicide [Hinosan Ediphenphos 50%, Bayer] showed highest and near fatal toxicity. A high index of clinical suspicion must be entertained and response to antidote must be judged carefully. One should not hesitate to use large doses of atropine in such cases (if needed)(2,3). All patients during this period recovered and were discharged without any fatality.

Table I__Clinical Features and Treatment Given in Insecticide and Fungicide Poisoning

Chemical nature
No. of cases(%)
Organophosphorus (OPC)
19 (50)
Carbamates
7 (18.4)
Endosulphans
2 (5.2)
Pyrethroids
5(13.2)
Fungicides
5(13.2)
Various types
available
HINOSAN (Ediphenphos 50%
Bayer)
THIMET (Phorate 105, Cynanid)
ROGOR
(Dimethoate 30%
Rallis)
THIODAN
(Endosulphan,
35%, Agro Evo)
USTAD
(Cypermethrin
10%, United
Phosphorus)
DITHANE
(Mancozeb
75%, Bayer)
FUZI ONE
(Isoprothiolane
40%, Rallis)
BEAM
METACID (Methyl parathion
50%, Bayer)
FURADAN
(Carbofuran 3%,
FMO)
ENOCEL
(Endosulphan
35%, Excel)
    (Tricyclazole
75%, Indofil)
MONOCIL (Monocrotophos
36%, NOCIL)
TARA 909       TILT 25 EC
(Propiconazole 25%,
Novartis)
EKALUX (Quinal phosphamidon 85%, Novartis)
Dimethoate 30%
SUMIDON (Phosphamidon
85%, Sudeshan)
         
DIMECRON (Phosphamidon
85%, Novartis)
         
Coomon clinical
features observed
Excessive salivation, lacrimation,
urination, diarrhea, pupillary
constriction. Tachycardia, muscle
fasciculation and CNS symptoms
in severe poisoning.
Similar like OPCs,
Shorter and lesser
magnitude
intoxication than
OPCs. No CNS
effect(2)
(cannot cross blood
brain barrier)
Convulsion,
dizziness
Allergic reaction
like sneezing,
running nose,
tremor, anxiety,
convulsion
Itching, redness
of skin, ataxia
vomiting,
diarrhea,
hypotension,
hypothermia
Fuzi One
associated with
anxiety, tremor,
convulsion.
In case of others-
non-specifice
Treatment given Atropine 0.05 mg/kg (repeated
every 10-15 min) and then
maintenance 0.02 to 0.05 mg/kg
(at least 24 h) 2 - PAM (25-50
mg/kg) infused over 15-30 min
as soon as possible (not later
than 24 h).
Atropine like OPCs
2-PAM
contraindicated(2,3)
Treated
symptomatically
Treated
symptomatically
Specific antidote
ascorbic acid
10-20 mg/kg IV
slowly
Treated
symptomatically

 

Subhasish Bhattacharyya,
Madhurima Lahiri,
Tutul Chattopadhyay*,

Departments of Pediatrics and *Community Medicine,
Medical College Hospital,
Kolkata 700 073, India.
Correspondence to: Dr. Subhasish Bhattacharyya,
B–3/8, Purbasha Housing Estate,
160, Manicktala Main Road,
Kolkata 700 054, India.
E-mail: dr_subhasish@yahoo.co.in

 

 References


1. Singh S, Singhi S, Sood NK, Kumar L, Walia BNS. Changing pattern of childhood poisoning (1970-1989): Experience of a large North India Hospital. Indian Pediatr 1995; 32: 331-336.

2. Mortencen ML. Management of acute childhood poisoning caused by selected insecticides and herbicides. Pediatr Clin North Amer 1986; 33: 421-445.

3. Zwiener RJ, Ginsburg CM. Organophosphate and carbamate poisoning in infants and children. Pediatrics 1988; 81: 121-126.

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