Aetiology, clinical characteristics and outcome in critically ill adult patients with acute deliberate self-poisoning admitted to acute medical care (AMC)

ABSTRACT: Background: Toxicology is a crucial aspect of critical care practice worldwide. Acute deliberate self-poisoning is a common cause of emergency room visits and a significant reason for ICU admissions. In India, such cases are predominantly treated in teaching hospitals, often without the necessary toxicological diagnostic facilities. Managing critically ill patients in these settings poses significant challenges due to limited resources, including the availability of specific antidotes and advanced life-support facilities. Aim: To evaluate the aetiology, clinical manifestations, and outcomes in patients with acute self-poisoning with suicidal intent admitted to acute medical care, and to explore the possibility of developing a prediction rule for mortality in these patients. Materials and Methods: This hospital-based prospective analytical study included 200 patients aged 18 years or older admitted to the acute medical care unit of SVRRGGH Tirupati over one year. Data collection involved history, physical examination, and necessary laboratory investigations to compute severity scores such as the APACHE II and SOFA. Statistical analysis was conducted using SPSS v23.0. Results: The study population had a mean age of 33.4±13.8 years, with the highest incidence in the 21-30 years age group (42%). Males constituted 64% of the cases. Organophosphate (OP) compounds were the most common poisons (54%). The predominant clinical presentations included vomiting (64%), altered sensorium (20%), and excessive salivation (15.5%). Most patients (85.5%) were discharged, while 11.5% died in-hospital, and 3% left against medical advice. Ventilatory support was required in 20.0% of the cases. Prognostic scores such as IPSC, APACHE II, and SOFA were significantly higher in non-survivors, suggesting their potential utility in outcome prediction. Conclusion: Acute self-poisoning in the Indian context is marked by a predominance of younger males and OP compound ingestion. Clinical manifestations vary, but vomiting and altered sensorium are common. Despite resource constraints, effective clinical assessment and supportive care can improve outcomes. Prognostic scores are valuable tools for predicting mortality in these patients, highlighting the need for targeted interventions and better diagnostic facilities in critical care settings. Keywords: Acute self-poisoning, Organophosphate compounds, Prognostic scores, Critical care, Suicidal poisoning, India. ##plugins.themes.academic_pro.article.details##