Publication:

Pills over pesticides: the rising burden of pharmaceutical poisoning among young adults in urban south India

Background Acute pharmaceutical poisoning represents an emerging public health challenge in urban India, with limited contemporary data on clinical profiles and outcomes. This study aimed to characterize the epidemiological patterns, clinical presentations, and determinants of complications in patients with acute drug poisoning.

Methods We conducted a prospective observational study over six months (June-December 2024) at a tertiary care center in Chennai, India. Adult patients (≥18 years) admitted with acute pharmaceutical poisoning were enrolled. Primary outcomes included organ dysfunction and in-hospital mortality. Secondary outcomes comprised length of stay and complication patterns. Multivariable logistic regression identified independent predictors of organ dysfunction.

Results Among 80 patients (mean age 36.8±11.2 years, 55% female), intentional self-harm accounted for 92.5% of cases. Benzodiazepines (17.5%) and NSAIDs (13.8%) were most frequently implicated. The majority (76.3%) presented 7-24 hours post-ingestion. Organ dysfunction occurred in 22 patients (27.5%), with no mortality observed. Independent predictors of organ dysfunction included delayed presentation >24 hours (OR 15.2, 95% CI 2.1-109.8, p=0.007) and ingestion >40 tablets (OR 8.9, 95% CI 2.8-28.4, p<0.001). Median length of stay was 5 days (IQR 4-6). All patients survived to discharge.

Conclusions Acute pharmaceutical poisoning predominantly affects young urban adults through intentional self-harm, replacing traditional pesticide poisonings. Early presentation and limiting ingested quantities are critical determinants of outcomes. These findings support the need for enhanced mental health services, medication safety measures, and public health interventions targeting pharmaceutical poisoning prevention.