Poisonings in patients of medical coma and their outcome at Mayo Hospital, Lahore

Abstract

Accidental, suicidal or homicidal ingestion of various substances is quite common in patients who often present as "Coma of unknown origin". The pattern of drug used in our society differs from the West. The knowledge of more popular substances in local community can be helpful in early diagnosis and management of these patients. In an ICU setup we studied the etiological distribution of coma resulting from poisoning and its outcome. Poisoning was the most frequently encountered cause (70 cases) comprising 19.18% of all cases of coma. There were a total of 218 patients with metabolic causes of coma, and out of these poisonings contributed the largest chunk (making up 32.11% of metabolic comas). Taken as a whole, poisoning has a relatively favourable outcome (25.71% mortality). The leading cause of poisoning encountered in our study was benzodiazepine poisoning i.e. 20 patients (28.57%) and all recovered. The second largest group was wheat preservative poisoning (15 patients, 21.42%), 07 patients died, with a mortality of 46.67%. Seven patients with narcotic overdose were all discharged, while one out of 04 patients of organophosphate poisoning (5.72%) and 05 out of 08 copper sulphate poisoning patients (11.43%) could not survive. In 07 patients, the agent could not be identified. Most poisonings encountered in our study were nonaccidental, and many were (27 patients, 38.57%) those patients who were victims of robbers. The favourite agent of these people was benzodiazepines (15 cases), Dhatura (4 patients), narcotic drugs (1 patient) and an unknown agent in 07 cases. Suicidal poisoning was the largest group with 31 cases (44.28%). We conclude that poisoning is the single largest cause of coma at our hospital emphasizes the need for poison information centres in our country, on the pattern prevalent in the West.