BIOCHEMICAL AND PHYSIOLOGICAL PREDICTORS OF MORTALITY IN PEADIATRIC POISONING CASES; A PHARMACOLOGY FORENSIC CROSSROAD

Background: To evaluate physiological and biochemical factors associated with mortality in children admitted with acute poisoning at a tertiary care hospital in Peshawar. Methods: A prospective observational study was conducted in the Department of Pediatrics, Hayatabad Medical Complex, Peshawar, from January 2023 to January 2024. A total of 72 children aged 1–12 years with confirmed or suspected poisoning were included. Demographic details, poisoning characteristics, vital signs, neurological status, and biochemical parameters were recorded at admission. Outcomes were compared between survivors and non-survivors using appropriate statistical tests, with a p-value <0.05 considered significant. Results: Of 72 cases, 14 (19.4%) children died. Mortality was significantly associated with rural residence (p=0.029), organophosphate ingestion (p=0.021), and delayed hospital presentation >6 hours (p=0.004). Physiological predictors of death included hypotension (p=0.007), SpO₂ <90% (p=0.002), and GCS <8 (p<0.001). Biochemical predictors included hyperkalemia (p=0.026), elevated creatinine (p=0.048), raised liver enzymes (p=0.021), and metabolic acidosis (p=0.014). Non-survivors had higher ICU admission, ventilation needs, complications, and longer hospital stays (all p<0.001). Conclusion: Paediatric mortality from poisoning is strongly influenced by delayed presentation, organophosphate ingestion, abnormal vital signs, and specific biochemical abnormalities. Early recognition and aggressive management of these predictors, along with community-level preventive measures, are crucial to reducing deaths in children with poisoning.