Our study aimed to identify the principal causes of acute poisoning attended in the emergency department between 2014 and 2021. Toxic agents involved in acute poisoning were medicines, pesticides, and chemical substances. The agents responsible for the poisoning were organophosphates, medications that depress the central nervous system (benzodiazepines and antidepressants). Less than 50% of the patients required ICU management in the first 24 hours. The mortality was less than 5% of the population related to the use of medications and pesticides.
The distribution of poisonings concerning sex and type of exposure was consistent with the outcomes reported in previous studies. Rageh et al. described a total of 9,713 acute poisonings being female (55.9%) most common gender, and the suicidal intent principal as the cause of poisoning (5). Pastó et al. described a similar proportion between men and women, suicidal intent was the principal motivation, and the mean age was 32 years (6). In the USA, psychoactive substance abuse (51.9%) has been described as the principal cause of poisoning, followed by suicidal intent in 23.6% (7). In a region of our country, a study identified that suicidal intent was 40.5% and a higher proportion of recreational use of psychoactive substances (26.6%), mainly in men (55.9%) and a median age of 23 years (8, 9). These findings are similar to our results. Compared with other studies, our results reveal a median age of 31 years, a higher proportion of men, and the most common type of exposure was suicidal intent in both genders. However, the frequency of these events concerning the mental illness group and the use of psychoactive substances as triggering causes of the events are low. Perhaps, this finding is related to the type of employment because not having it or having informal jobs represented more than 50% of the cases. This contrast with the poverty index in our region described a high level of informal employment (67.5%), low educational ( 39.4%), school lag (23.8%), long-term unemployment (12.1%), and health insurance (10.2%) during 2018 (10). Another factor to explain this outcome is the underreporting of mental illness diagnoses due to the social stigma, and it could contribute to suicidal ideation (11).
Rageh et al. showed that rodenticides, drug overdoses, and chemical substances were the causative agents with the highest incidence (5). Naseri K et al. found that the most common etiology was medications (48%), narcotics (25%), and chemicals (10%) (12). Helal et al. found that acetaminophen was the most common agent of acute poisoning (13). A study in New Zealand described that the medicines most involved in medication poisoning were paracetamol, antidepressants, and quetiapine (14). In our results, medications were the most used group of substances (central nervous system depressants).
A research study reported in Spain described that the principal medications involved in poisoning were medications (62.7%), opiates/designer drugs (19%), and alcohol (11%) (6). In the US, the annual report of the national poisoning data system informed that during 2021 the substances mainly involved were analgesics (11.2%), household cleaning substances (10.7%), cosmetic products (5.88%), antidepressants (5.61%) and antipsychotics (4.73%), predominating the group of medications (7). In our country, the national statistics reported that pesticides, medicines, and psychoactive substances were the principal causes of acute poisoning in 2020 (9). Likewise, a descriptive study showed that the principal causes were psychoactive substances (41.1%), medications (27.5%), and pesticides (24.8%) (8).
However, in Colombia and our region, there is underreporting of acute poisonings, and the epidemiological data on the toxicological profile of the population that consults is incomplete. Our results showed that the first cause of poisoning is medicines, followed by pesticides, chemical substances, and psychoactive substances. There is variability in the possible causes of intoxication in the different places, and it is related to the self-injurious intention and the availability or ease of accessing the substances. In our environment, pesticides and medicines, despite being regulated by government entities (15), of them can be obtained free of charge, explaining the use of these agents. Given that the department of Valle del Cauca is one of the four departments in agricultural production according to the latest report of the National Agricultural Survey (16), this could explain the frequent use of this group of toxic agents in our population.
The most proportion of patients who attended our emergency room were received from the first-level hospital. According to the sustainability reports of our hospital, the percentage of patients affiliated with contributory or subsidized regimes was 75%, likewise with low and medium socioeconomic status. Our university hospital receives more than 6,000,000 patients from southwestern Colombia.
Our hospital is a reference hospital in southwestern Colombia due to its logistical, human resource, and technological capacity in medical care of serious diseases. It documented 91.000 patients attended the emergency room during 2022 (4% growth compared to the previous year) (17).
The median care time for patients with acute poisoning from exposure to the start of first aid for poisoning was 180 minutes (84–348). Kaya et al. reported a time of 208 minutes (IQR: 15–660) presenting times longer than ours (18). In our study, 95% of the patients admitted were referred from first and second-level hospitals, which could explain the variability in the care time.
The first and second-level hospitals realized first aid management, including decontamination measures in 39.4% (160 patients). In the United States, two studies described that the use of activated charcoal was 1.97% and 3.6%, gastric lavage 0.08% and 0.04%, and total intestinal irrigation 0.08 and 0.11% (7, 19).
Lund C et al. described that 9–16% used decontamination measures in your study(20). Studies in Russia and India described that the use of this measure was 22% and 35% (21, 22).
In Bolivia, an organophosphates study evidenced that gastric lavage in patients with intoxication was 96% (23).
Currently, the available evidence about decontamination measures does not impact morbidity and mortality, and could generate adverse events and delay the administration of therapeutic measures that could improve outcomes (24–29).
The cholinergic and sedative/hypnotic toxidrome was the most frequent in our study. This result is related to the secondary effects of organophosphates and depressant medications on the central nervous system.
Our mortality was similar to the other countries in Asia and Africa, which reported a mortality of 4–8% (5, 30). However, in European countries (such as Spain), the mortality has been lower (0%) (6). In 2021, the USA reported a mortality of 0.22%, and the principal causes of these deaths were acetaminophen (8.94%), miscellaneous hypnotics/sedatives/antipsychotics (8.08%), alcohols (7.73%), and pharmaceutical/illegal opioid preparations (7.59%) (7). In Turkey, a study reported a mortality of 1.1% (18). Perhaps, the mortality is higher in our study due to the group of poisoning agents. In our group, the mortality in the pesticide poisoning group was 4.5%, lower than reported in some studies (8%) (30, 31). However, our mortality was higher compared to one study in the USA (0.07%) (32). These studies do not identify pesticide poisoning, which explains the difference between our outcomes. Another reason could be associated with access to health services, the opportunity for care, and response capacity better than in our country.
One of the strengths of our study was a large sample of patients diagnosed with acute poisoning. We could obtain adequate quality data in the electronic medical records due to a straight review in the database.
This retrospective study was limited to a single hospital center. There were missing data related to the care times and medical management (decontamination management) due to first and second-level hospitals were not described this information.
However, we obtained relevant data for the region that can serve as a basis for other studies and take measures to generate public health policies.