A cohort study on poisons, clinical insights, management of poisoning, and predictors of mortality in Pakistan

Acute poisoning is a severe global public health issue that involves injury or death caused by exposure to an exogenous substance through any route. This study evaluated the most common poisons, reasons for poisoning, clinical management of poisoning cases, and their associated outcomes. One-year prospective cohort study executed at an academic medical center in Sindh, Pakistan. The predictors of outcomes are examined using a binary logistic regression model. Among 1404 enrolled patients, the majority were male (57.1%), aged 16-30 years (63.2%) and married (77.6%). Organophosphate compounds (42.8%) were the primary reasons for poisoning. Clinical manifestations as abnormalities in blood pressure (AOR = 1.76; 95% CI: 1.04-2.97; p = 0.034), abnormal consciousness (AOR = 10.41; 95% CI: 5.91-18.35; p < 0.001), dyspnea (AOR = 3.20; 95% CI: 1.72-5.96; p < 0.001), bronchorrhea (AOR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and salivation (AOR = 2.70; 95% CI: 1.38-5.29; p = 0.004) were associated with higher odds of death. Symptomatic management was achieved through the administration of proton pump inhibitors (89.0%) and antidotes, such as pralidoxime (49.9%). The findings highlight the need for stricter regulation of organophosphate storage and sales, alongside community awareness campaigns. Establishing regional poison and antidote centers, ensuring early recognition of clinical manifestations, and implementing standardized management protocols may reduce mortality risk.