Human & Experimental Toxicology (2005) 24: 279 - 285
www.hetjournal.com
An epidemiological study of poisoning cases
reported to the National Poisons Information
Centre, All India Institute of Medical
Sciences, New Delhi
Amita Srivastava, Sharda Shah Peshin*, Thomas Kaleekal and Suresh Kumar Gupta
National Poisons Information Centre, Department of Pharmacology, All India Institute of Medical Sciences,
New Delhi, India
A retrospective analysis of poisoning- calls received by the
National Poisons Information Centre showed a total of
2719 calls over a period of three years (April 1999-
March 2002). The queries were made on poisoning
management (92%) and information (8%) about various
products and functioning of the centre. The data were
analysed with respect to age, sex, mode and type of
poisoning. The agents belonged to various groups: house-
hold products, agricultural pesticides, industrial chemi-
cals, drugs, plants, animal bites and stings, miscellaneous
and unknown groups respectively. The age ranged from
less than 1 to 70 years, with the highest incidence in the
range of 14-40 years, with males (57%) outnumbering
females (43%). The most common mode of poisoning was
suicidal (53%), followed by accidental (47%). The route of
exposure was mainly oral (88%). Dermal (5%), inhalation
and ocular exposure contributed 7% to the total. The
highest incidence of poisoning was due to household
agents (44.1%) followed by drugs (18.8%), agricultural
pesticides (12.8%), industrial chemicals (8.9%), animals
bites and stings (4.7%), plants (1.7%), unknown (2.9%)
and miscellaneous groups (5.6%). Household products
mainly comprised of pyrethroids, rodenticides, carba-
mates, phenyl, detergents, corrosives etc. Drugs impli-
cated included benzodiazepines, anticonvulsants,
analgesics, antihistamines, tricyclic antidepressants,
thyroid hormones and oral contraceptives. Among the
Introduction
Poisoning is a major health problem in many
developed countries but it is ill defined in develop-
ing countries, including India.1 -4 In our country, the
problem is getting worse with time, as newer drugs
and chemicals are developed in vast numbers, and
there are no stringent rules and regulations for their
dispensing and use. There are more than 9 million
*Correspondence: Sharda Shah Peshin, National Poisons Infor-
mation Centre, Department of Pharmacology, All India Institute of
Medical Sciences, New Delhi 110029, India
E-mail: s-peshin~hotmail.com
2005 Edward Arnold (Publishers) Ltd
Downloaded from het.sagepub.com at PENNSYLVANIA STATE UNIV on September 19, 2016
agricultural pesticides, aluminium phosphide was the
most commonly consumed followed by organochlorines,
organophosphates, ethylene dibromide, herbicides and
fungicides. Copper sulphate and nitrobenzene were
common among industrial chemicals. The bites and
stings group comprised of snake bites, scorpion, wasp
and bee stings. Poisoning due to plants was low, but
datura was the most commonly ingested. An alarming
feature of the study was the high incidence of poisoning
in children (36.5%). The age ranged from less than 1 to
18 years and the most vulnerable age group included
children from less than 1 year to 6 years. Accidental
mode was the most common (79.7%). Intentional attempts
were also noticed (20.2%) in the age group above
12 years. The present data may not give an exact picture
of the incidence of poisoning in India, but represents a
trend in our country. The Poisons Information Centre
plays a vital role in providing timely management guide-
lines including the supply ofnecessary antidotes from the
recently established National Antidote Bank, thereby
helping to save precious lives. Human & Experimental
Toxicology (2005) 24, 279-285
Key words: agricultural pesticides; Antidote Bank; drugs; house-
hold products; Poisons Information Centre; telephone queries
natural and synthetic chemicals worldwide, and
the list keeps growing inexorably.5 Pesticides are
the commonest cause of poisoning and according
to World Health Organization (WHO) estimates,
approximately 3 million pesticide poisonings occur
annually worldwide, causing more than 220 000
deaths. Developing countries like Sri Lanka and
India report high rates of toxicity and death.6'7 India
accounts for one-third of pesticide poisoning cases
in the third world and the worst affected are farm
workers. The reason could be attributed to the
increasing number of toxic chemicals and their
10.1 191/0960327105ht527oa
 Acute poisoning cases reported to NPIC, AIIMS, New Delhi
A Srivastava et al.
280
large-scale use without proper testing of their toxic
properties. Banned products also continue to flow
into the market. Household agents like cleaning
products or medicines have further widened the
spectrum of toxic products to which people may be
exposed.
The scale of the problem is enormous due to the
increased incidence of morbidity and mortality.2
Improvement in the preventive and management
programme can be brought about by identification of
high risk circumstances, susceptible groups within
the population, chemical substances and commer-
cial products involved in poisoning cases in the
community. In India, literature reports providing
such information are scant.4'810 The problem of
poisoning received attention a few years ago in
our country and the first National Poisons Informa-
tion Centre (NPIC) was established in the Depart-
ment of Pharmacology at the All India Institute of
Medical Sciences in 1995.11 The centre, which
provides a round-the-clock service, is a specialized
unit providing information in principle to the
whole community. Its main function includes the
provision of toxicological information and advice
on the management of the poisoned patient to the
inquirer. International databases on poisoning man-
agement and drug reactions and continuous sys-
temic collection of data from the library form the
backbone of this service. Besides, NPIC is also a
participant of the INTOX project of IPCS/WHO.
Trained poisons information specialists provide
information by telephone, fax or e-mail on the
management of poisoning to treating physicians
and on first aid to the general public. The relevant
details about management are conveyed to the
hospital emergency centres and private practi-
tioners. In case no treatment is warranted, reassur-
ance is given.
Although there are a number of epidemiological
studies on poisoning based on telephone inquires
both in adults and in children from different parts
of the world,612 15 reports from India are few.16 18
So the present study was carried out to determine
the pattern of poisoning in adults and in children in
order to highlight the common agents implicated
and plan a concerted prevention programme.
Material and methods
The poisoning calls received by the centre were
analysed for a period of three years (April 1999-
March 2002), and entered into a preset proforma
and then into a retrievable database. The call details
included the time, date, mode of inquiry, enquirer's
name and address, patient's or victim's age, sex,
Downloaded from het.sagepub.com at PENNSYLVANIA STATE UNIV on September 19, 2016
symptoms and treatment given. After consulting the
databases and relevant literature, all details wanted
by the physician are conveyed by a follow-up call.
The information provided to the enquirer is docu-
mented. The implicated agents were broadly di-
vided into eight main categories. The calls were
categorized into poisoning and information calls.
The programme provided the correlation of inci-
dence with age, sex, route of exposure, mode
of poisoning and the type of poisoning. Calls
based on incidence of poisoning in children were
categorized into four groups: Gr. I (0-6 years), Gr. II
(>6-12 years), Gr. III (>12-16 years) and Gr. IV
(> 16- 18 years) according to age.
Results
In a period of three years (April 1999-March 2002) a
total of 2719 calls were received by the NPIC. There
were 2494 calls (92%) on management of poisoning
and 225 calls (8%) seeking information on various
poisons and functioning of NPIC. The age ranged
from less than one year to 70 years with the highest
incidence in the range of 14-40 years. Males out-
numbered females (M = 1426, F = 1068). The most
common mode of poisoning was suicidal (53%),
with accidental poisonings contributing 47% to the
total. In the majority of cases, the route of exposure
was oral (88%), followed by dermal exposure (5%)
mainly comprising of bites and stings.
The various types of agents implicated are shown
in Table 1. Household products (44.1%) were the
most frequent cause of poisoning followed by drugs
(18.8%), agricultural pesticides (12.8%), industrial
chemicals (8.9%), animals bites and stings (4.7%),
plants (1.7%), unknown (2.9%) and miscellaneous
groups (5.6%) as shown in Figure 1.
Among the household products, the most com-
mon agents consumed were rodenticides, pyre-
throids, carbamates, organophosphates, phenyl,
elemental mercury, detergents and corrosives. The
highest number of calls were due to household
pesticides (46.8%) which included rodenticides,
zinc phosphide, barium carbonate and bromadio-
lone. Baygon (propoxur) was the most commonly
consumed agent among carbamates. The common
organophosphates implicated were Tik-20 (Feni-
trothion), Licel and Finit (Malathion). Various insect
repellants, aerosols and mats containing different
pyrethroids have been frequently involved in poi-
soning. In addition 'Parad' (Elemental mercury),
used for preserving grains in households, and
thermometer mercury contributed 10.7% to the
group. Phenyl ingestion was reported in 10.3%
cases. Poisoning due to naphthalene balls (3.9%),
 Acute poisoning cases reported to NPIC, AlIMS, New Delhi
A Srivastava et al.
281
Table 1 Types of poisoning

Category Number Percentage

1 Household products 1102 44.1%
Pesticides (rodenticides, pyrethroids, organophosphates, carbamates etc. 516
Phenyl 114
Thermometer mercury/Parad 119
Naphthalene 44
Kerosene 25
Detergents & corrosives 76
Antiseptics 54
Thinner 30
Others (silica gel, button battery, talcum powder, hairdye, H202, camphor etc.) 124
2. Agricultural products 320 12.8%
Aluminium phosphide 120
Organophosphates 60
Organochlorines 75
Ethylene dibromide 30
Herbicides 22
Pyrethroids (fenvelerate, cypermethrin) 13
3. Industrial chemicals 224 8.9%
Copper sulphate 48
Hydrocarbons 20
Nitrobenzene 26
Alcohols/methanol/ethanol 24
Ammonia 6
Sulphuric acid, hydrochloric acid 8
Acetone 5
Mercurochrome, potassium permanganate 9
Gases (acetylene, argon, methane) 7
Heavy metals (Pb, Hg, Th, As) 6
Turpentine oil 11
Others (ethylene glycol, isopropyl alcohol, chloroform, formaldehyde, calcium carbide, 54
petrol, spirit, amyl nitrite)
4. Drugs 470 18.8%
Benzodiazepines 83
Anticonvulsants 74
Analgesics 47
Antihistamines 35
Ayurvedic/homeopathic 19
Antipsychotics 12
Mixed drugs 23
Tricyclic antidepressants 4
Others (cardiovascular drugs, thyroid hormones, iron, antidiarrhoeals, oral contraceptives) 173
5. Animal bites & stings 118 4.7%
Snake 62
Scorpion 24
Honey bee/wasp 9
Spider, lizard 7
Others (dog, monkey, mongoose, rat, jelly fish) 16
6. Plants 44 1.7%
Yellow oleander 5
Datura 28
Bhang 5
Others 6
7. Unknown 74 2.9%
8. Miscellaneous 142 5.6%

detergents and corrosives (6.8%), antiseptics (4.9%),
kerosene (2.2%) was also reported. The other house-
hold products contributed 11.2% calls to this group.
Next to household products, drugs were the most
commonly consumed (18.8%). The highest inci-
dence was due to benzodiazepines (17.6%) followed
by anticonvulsants (15.7%), mainly carbamazepine
and phenytoin, analgesics (10%), antihistamines
(7.4%), ayurvedic and homeopathic preparations
(4%) etc. Mixed drug ingestions were also observed
(4.8%). The incidence of poisoning due to antidiar-
rhoeals, antimalarials and cardiovascular drugs was
low. Isolated cases involving ingestion of corticos-
teroids, calcium channel blockers, anti-inflamma-
tory drugs, vitamins, oral contraceptives etc.
(36.8%) were also reported.

Downloaded from het.sagepub.com at PENNSYLVANIA STATE UNIV on September 19, 2016

 Acute poisoning cases reported to NPIC, AIIMS, New Delhi
A Srivastava et al.
282
18.8%
Figure 1 Incidence of poisoning due to various agents.
Agricultural pesticides contributed 12.8% to the
total. The highest incidence (37.5%) was due to
aluminium phosphide, a very effective grain fumi-
gant. Organochlorines were incriminated in 23.4%
cases and the common products consumed were y-
benzenehexachloride, endosulfan and aldrin. Other
pesticides included organophosphates (Quinalphos,
Chlorpyriphos, Monocrotophos etc.), pyrethroids
(Cypermethrin, Fenvelerate etc.), ethylene dibro-
mide and various herbicides.
A total of 224 calls (8.9%) due to industrial
chemicals, consisting mainly of copper sulphate,
nitrobenzene, hydrocarbons, alcohols including
methanol, turpentine oil etc. were recorded. There
was a high incidence of poisoning due to copper
sulphate (21.4%) followed by nitrobenzene (11.6%),
alcohols (10.7%) and turpentine oil (4.9%). The
other agents ingested comprised of ethylene glycol,
isopropyl alcohol, ammonia, acetone, heavy metals,
gases, screen-printing agents etc. Bites and stings
(4.7%) mainly comprised of snake bites (52.5%).
Scorpion stings, wasp and dog bites were also
reported.
12%
14%
9%
.8GroupI
Figure 2 Agewise distribution of childhood poisoning.
Downloaded from het.sagepub.com at PENNSYLVANIA STATE UNIV on September 19, 2016
12.8%
Poisoning due to plants was low. Datura, a plant
with ANS toxicity commonly found along road-
sides, cornfields and waste areas, was commonly
ingested (65%), followed by yellow oleander
and bhang. There were a number of calls due
to unknown products (2.9%). The number of calls
due to a miscellaneous group was 5.6%, consist-
ing mainly of food poisoning, lizards in food, holi
dyes etc.
There was a high incidence of pesticide poison-
ing, if only pesticides belonging to household
products and agricultural groups were taken into
account, contributing 33.5% (n = 836) to the total.
A prominent feature of the study was a high
incidence of poisoning in children (36.5%), with
males outnumbering females (M = 63.1%, F =
36.8%). In the majority of cases, the route of
exposure was oral (96.7%), followed by dermal
exposure (3.2%) comprising bites and stings. The
mode of poisoning was mainly accidental. However,
in adolescents intentional attempts were also
noticed (20.2%) in Gr. III and IV. The most vulner-
able age group was Gr. I (64.7%) (Figure 2). The
5~~~~~5
roup: G ING:i:,:,olup: IV

incidence of poisoning due to household products
was the highest (47.0%) followed by drugs (21.8%),
agricultural pesticides (9.1%), industrial chemicals
(7.9%), bites and stings (3.2%), plants (1.5%),
unknown (4.0%) and miscellaneous group (5.3%).
Discussion
A retrospective three-year study of telephone calls
received from all over the country by the NPIC was
carried out. There was a total of 2719 calls received
by the centre, which is comparatively much less
than the number received by some other centres of
the world.19-21 However, the NPIC in Sri Lanka also
reported fewer calls in the first 10 years.6 The recent
establishment of the NPIC, lack of central registry,
social stigma associated with poisoning in India,
especially in the case of females, and the absence of
a poisons prevention campaign could be the likely
reasons for under-reporting of calls to the centre.
Of the total calls received by the centre, 2494
(92%) were made by physicians regarding the
management of various poisonings, and 225 calls
(8%) were made by the general public seeking
information on first-aid measures and the function-
ing of the centre and government agencies requiring
details about various products. The queries made
varied widely, from the nature of the substance
involved in poisoning, symptoms, supportive and
symptomatic treatment to specific antidotes, their
dosage and availability. The age ranged from less
than one year to 70 years, with the highest incidence
in the range of 14-40 years. There was a higher
incidence of poisoning in males (57%) as compared
to females (43%). The mode of poisoning encoun-
tered was mainly suicidal (53%) followed by acci-
dental ingestion (47%) in concordance with other
reports. 4,22,23
An increasing trend of suicidal mode in males as
compared to females was noticed, contrary to a
higher female/male ratio in intentional poisoning
as reported in other studies.24'25 Low socioeconomic
status, rapid urbanization, unemployment and other
frustrations could probably be contributing factors
for higher suicide rates among men.26'27
The route of exposure was oral (88%) in the
majority of the cases, followed by dermal (5%)
comprising bites and stings. Inhalation and ocular
exposures contributed 7% to the total.
Because there are no epidemiological studies in
India based on the telephone data of Poisons
Information Centres, comparison cannot be made
regarding the pattern of poisoning. However, the
retrospective hospital-based studies, when taken
into account, showed a different trend. While
Downloaded from het.sagepub.com at PENNSYLVANIA STATE UNIV on September 19, 2016
Acute poisoning cases reported to NPIC, AIIMS, New Delhi
A Srivastava et al.
283
various reports have shown copper sulphate, orga-
nophosphates and aluminium phosphide to be the
top-ranking poisoning agents,8'9'26 the present study
showed the highest incidence of poisoning due to
household products corroborated by a few reports
in literature.28'29 Among the household products,
rodenticides, pyrethroids, organophosphates and
carbamates were commonly consumed, with the
highest number of calls due to rodenticides com-
prising barium carbonate, zinc phosphide and
bromadiolone, used frequently in households. The
second largest category among the household pro-
ducts consisted of pyrethroids, which included
insect repellants, aerosols and mats. As these pro-
ducts are less toxic, their introduction to the market
may be responsible for the phasing out of more toxic
organophosphates such as Tik-20 (Fenitrothion) and
Finit (Malathion), which were more frequently used
in the past. Strict adherence to instructions recom-
mending safe storage of household products and
their use in a prescribed manner may help in
achieving a degree of safety.
Poisoning due to drugs is on the increase. Our
study shows that benzodiazepines have been fre-
quently ingested. Similar studies indicating high
incidence of poisoning due to this class of drugs
have been reported in literature.29 32 A high inci-
dence of poisoning by anticonvulsants has also been
recorded in the present study. Further, ingestion
of analgesics, antihistamines and antipsychotics is
also reported. Poisoning due to various ayurvedic
preparations (such as Aswagandha Churna, Sarp-
gandha, Bhringraja Tel, Dabur Lal Tel), homeopathic
(such as Belladonna, Camphora, Aconitum) and
unani (such as Suhaga, Joshanda, Anoshdaru) has
been recorded. Accidental exposure to drugs may be
primarily attributed to careless storage and easy
availability without prescription, and therapeutic
error.
Amongst the agricultural pesticides, the highest
incidence was due to aluminium phosphide, which
is a very effective grain fumigant commonly avail-
able and used by the northern states of India.
The present study recorded fewer cases compared
to earlier reports, probably because of restrictions
imposed on its sale.33'34 Poisoning due to organo-
phosphates and organochlorines has also been
recorded but to a lesser extent as compared to
countries like Sri Lanka where the highest incidence
has been recorded due to these agents.35
High incidence of poisoning by agrochemicals has
also been reported by the other Poisons Control
Centres.14'36 Pesticides have also previously been
implicated as possible poisoning agents in India.7
Ignorance about proper storage in households and
 Acute poisoning cases reported to NPIC, AIIMS, New Delhi
A Srivastava et al.
284
easy availability of pesticides could be mainly res-
ponsible for both suicidal and accidental poisoning.
Snake bites were common in the animal bites and
stings group, mainly reported during monsoons
from rural areas. The number of calls due to
poisoning by plants was low. Datura was ingested
frequently.
An important feature of the study was the high
incidence of poisoning in children (<1-18 years),
similar to other reports in the literature.19'37-39
Children in the age group of less than 12 years,
with males outnumbering females, were frequently
involved in accidental poisonings, corroborating
other reports.1940 Reversal of gender distribution
and increased rate of intentional poisoning has
been recorded in the age range of 12-18 years.
The highest incidence was due to household
products with an increasing ingestion of pyrethroids
involving mainly insect repellant mats followed
by drugs in the group less than 12 years of age.
A retrospective study from the Poisons Control
Centre, Spain also reports a high incidence of
poisoning in children under 12 years of age invol-
ving drugs.22'41 Other agents involved included
phenyl, naphthalene, thermometer mercury, kero-
sene, household pesticides. Intentional ingestion
of aluminium phosphide in Groups III and IV
was recorded among the agricultural pesticides
by children. Consumption of agricultural pesticides
by children is well reported.28 42'43 Introduction
of child resistant closures, parental and care-
taker's education about proper storage of drugs
and common household products can reduce
the problem of childhood poisoning to a great
extent.
References
1 Seneviratne B, Thambipillai S. Pattern of poisoning in
developing agricultural country. Br J Prev Soc Med
1974; 28: 32-36.
2 Batra AK, Keoliya AN, Jadhav GU. Poisoning: an
unnatural cause of morbidity and mortality in rural
India. JAssoc Physicians Ind 2003; 51: 955-59.
3 Senanayake N, Peiris H. Mortality due to poisoning in
a developing agricultural country: trends over 20 years.
Hum Exp Toxicol 1995; 14: 808 -11.
4 Lall SB, Peshin SS, Seth SD. Acute poisonings - a ten
years retrospective hospital based study. Ann Nati
Acad Med 1994; 30: 35 -44.
5 Current Index of Medical Specialties. Poisoning and its
management, Part I. May-August. 1997; 20: 49.
6 Fernando R. The National Poisons Information Centre
in Sri Lanka: the first ten years. Clin Toxicol 2002; 40:
551- 55.
Downloaded from het.sagepub.com at PENNSYLVANIA STATE UNIV on September 19, 2016
As the cases were not followed up, the present
study does not indicate the percentage mortality. It
is anticipated that the mortality in case of organo-
phosphates must be low, as the antidotes for this
poisoning (atropine and 2-PAM) are available. Most
of the other cases can also be managed effectively as
the centre provides the antidotes, information on
dosing schedule, indications, contraindications,
side effects etc. However, mortality due to alumi-
nium phosphide, which ranks on the top of agricul-
tural pesticides consumed, still remains a matter of
great concern. Because its mechanism of action is
not clear, the clinical course remains complicated.
In India, since the establishment of the NPIC
in 1995 and the centre providing a service to the
public and professionals, the number of calls has
been increasing gradually. However, there might
be under-reporting of calls to the centre due to
unawareness of the role of the Poisons Information
Centre and thus underutilization of the services.
There might actually be a variable and even higher
incidence. Further, it may be emphasized that
because of the associated social stigma with poison-
ing, especially in females attempting suicides, it is
possible that calls to the centre are avoided.
Further, since this study has highlighted that
household products are the main agents implicated
in poisoning, efforts should be directed to create
awareness among people by undertaking education
of parents and caretakers, especially those taking
care of children, by distributing educational leaflets,
brochures and handouts on proper storage, use and
disposal of various chemicals used at home. Cam-
paigns in the media and educational programmes
could also help in highlighting the preventive
measures.
7 Thomas M, Anandan S, Kuruvilla PJ, Singh PR, David
S. Profile of hospital admissions following acute
poisoning - experiences from a major teaching hospi-
tal in South India. Adverse Drug React Toxicol Rev
2000; 19: 313-17.
8 Chuttani HK, Gulati PS, Gulati S, Gupta DM. Acute
copper sulfate poisoning. Am J Med 1965; 39: 849-
54.
9 Singh S, Sharma BK, Wahi PL, Anand BS, Chugh KS.
Spectrum of acute poisoning in adults (10 years
experiences). J Assoc Phys India 1984; 32: 561-63.
10 Lall SB, Peshin SS, Seth SD. Retrospective five year
study of acute poisoning cases at the All India Institute
of Medical Sciences. J Forensic Med Toxicol 1989; 6:
1 -8.
11 Lall SB, Peshin SS. Role and functions of Poisons
Information Centre. IndJPaediatr 1997; 64: 443-49.

12 Yang CC, Wu JF, Ohg HC, Kuo YP, Deng JF, Ger J.
Children poisoning in Taiwan. Ind J Pediatr 1997; 64:
469-483.
13 Jaraczewska W, Kotwica M. Acute poisonings with
drugs. A review of the data collected at the National
Poison Information Centre during the period 1991-
1995. Przegl Lek 1997; 54: 737-40.
14 Yang CC, Wu JF, Ohg HC, Hung SC, Kuo YP, Sa CH,
Chen SS, Deng JF. Taiwan National Poison Centre:
epidemiological data 1985-1993. J Toxicol Clin Tox-
icol 1996; 34: 651-63.
15 Litovitz TL, Felberg L, Soloway RA, Ford M, Geller R.
Annual report of the American Association of Poison
Control Centres Toxic Exposures Surveillance System.
Am JEmerg Med 1994; 13: 551- 97.
16 Gupta SK, Peshin SS, Srivastava A, Kaleekal T,
Pandian TV. An epidemiological pattern of poisoning
in India. Pharmacoepidemiol Drug Saf 2002; 11: 73-
74.
17 Gupta SK, Peshin SS, Srivastava A, Kaleekal T,
Pandian TV. Epidemiology of acute poisoning. Nat]
Med J Ind 2002; 15: 177.
18 Gupta SK, Peshin SS, Srivastava A, Kaleekal T. A study
of childhood poisoning at National Poisons Informa-
tion Centre, All India Institute of Medical Sciences,
New Delhi. I Occup Health 2003; 14: 191- 96.
19 Goto K, Endoh Y, Kuroki Y, Yoshioka T. Poisoning in
children in Japan. Ind I Pediatr 1997; 64: 461-68.
20 Wolfle J, Kowalewski S. Epidemiology of ingestions in
a Regional Poison Control Centre over twenty years.
Vet Hum Toxicol 1995; 37: 367-68.
21 Litovitz TL, Clark LR, Soloway RA. 1993 Annual
report of the American Association of Poison Control
Centres. Toxic Exposure Surveillance System. Am J
Emerg Med 1994; 12: 546-84.
22 Repetto MR. Epidemiology of poisoning due to phar-
maceutical products, Poison Control Centre, Seville,
Spain. Eur J Epidemiol 1996; 13: 353 -56.
23 Weissman MM. The epidemiology of suicide attempts
1960-1971. Arch Gen Psychiatry 1974; 30: 737-46.
24 Smith JS, Davidson K. Changes in the pattern of
admission for attempted suicide in New Castle upon
Tyne during the 1960's. Br Med J 1974; 4: 412 -15.
25 Bridges PK, Koller KM. Attempted suicide: a compara-
tive study. Compr Psychiatry 1966; 7: 240- 47.
26 Singh D, Jit I, Tyagi S. Changing trends in acute
poisoning in Chandigarh zone, a 25 year autopsy
experience from a tertiary care hospital in northern
India. Am J Forensic Med Pathol 1999; 20: 203-10.
27 Sharma BR, Harish D, Sharma V, Viz K. Poisoning in
northern India: changing trends, causes and preven-
tion thereof. Med Sci Law 2002; 42: 251-57.
Downloaded from het.sagepub.com at PENNSYLVANIA STATE UNIV on September 19, 2016
Acute poisoning cases reported to NPIC, AlIMS, New Delhi
A Srivastava et al.
285
28 Menon P, Kodama AH. Hawaii Poison Centre data
reveals a need for increasing hazard awareness about
household products. Hawaii Med J 1998; 57;476-
48.
29 Lawson AHH, Mitchell I. Patient with acute poisoning
in general medical unit (1966-71). Br Med J 1972; 4:
153-56.
30 Manhaioni PF. Pattern of acute intoxication in Flor-
ence; a comparative investigation. Intensive Care Med
1991; 17: S24-S31.
31 Jacobsen D, Frederichsen PS, Knutsen KM, Sorum Y,
Talseth T, Odegaard DR. A prospective study of 1212
cases of acute poisoning: general epidemiology. Hum
Toxicol 1984; 3: 93-106.
32 Proudfoot AT, Park J. Changing pattern of drugs used
for self poisoning. Br Med J 1978; 1: 90-93.
33 Bajaj R, Wasir HS. Epidemic aluminium phosphide
poisoning in northern India. Lancet 1988; 1: 820-
21.
34 Siwach SB, Yadav Dr, Arora B, Dulal S, Jagdish. An
epidemiological, clinical and histopathological study.
J Assoc Phys India 1988; 36: 595-96.
35 Fernando R. Pesticides poisoning in the Asia-Pacific
region and the role of a regional information network.
Clin Toxicol 1995; 33: 677-82.
36 Wesseling C, Castillo L, Elinder CG. Pesticide poison-
ings in Costa Rica. Scand I Work Environ Health 1993;
19: 227-35.
37 Jaraczewska W, Czerczak S, Kotwica M, Jarosz A.
Analysis of toxicological information rendered by the
staff of the National Poison Information Centre and
physicians at the clinic of acute poisoning of the
Institute of Occupational Medicine in Lodz. Przegl-
Lek 1996; 53: 594-99.
38 Kotwica M, Rogaczewska A. Causes of poisoning in
children during the period 1990- 1993. Przegl-Lek
1996; 53: 329-33.
39 Scherz R. Prevention of childhood poisoning - a
community project. Pediatr Clin North Am 1970; 17:
713-27.
40 Deeths TM, Breeden JT. Poisoning in children - a
statistical study of 1057 cases. JPediatr 1971; 78: 299-
305.
41 Leveridge YR. The pattern of poisoning in Costa Rica
during 1997. Vet Hum Toxicol 1999; 41: 100- 102.
42 Spann MF, Blondell JM, Hunting KL. Acute hazards to
young children from residential pesticide exposure.
Am J Pub Health 2000; 90: 971- 73.
43 Sumner D, Langley R. Pediatric pesticide poisoning in
the Carolinas; an evaluation of the trends and proposal
to reduce the incidence. Vet Hum Toxicol 2000; 12:
101 -103.