Document Type : Original Article
Authors
- Sadaf Hanif 1
- Muhammad Sohaib 2
- Sana Hirani 3
- Summaya Fatima 4
- Ashraf Buzdar 4
- Fatima Sohail 5
- Fatima Khan 4
- Sher M Sethi 6
1 Senior Instructor, Internal Medicine & Critical Care, Aga Khan University Hospital, Karachi, Pakistan
2 Anesthesia & Critical Care, Aga Khan University Hospital, Karachi, Pakistan
3 Clinical Nurse Specialist, Internal Medicine & Nursing Division, Aga Khan University Hospital, Karachi, Pakistan
4 Resident, Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
5 Senior Medical Officer, Internal Medicine, Aga Khan University Hospital, Pakistan
6 Instructor, Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
Abstract
Background: Poisoning is a major global health challenge and often requires intensive care due to high morbidity and mortality. We evaluate epidemiological trends, clinical features, and outcomes of adults admitted to the ICU with toxic exposures or substance misuse over 20 years.
Methods: We conducted a retrospective review at Aga Khan University Hospital, Karachi, including adults (≥18 years) admitted to the medical ICU between 2002 and 2022. Statistical analyses (Chi-square, Fisher’s exact, Mann-Whitney U, and logistic regression) assessed associations and predictors of mortality.
Results: Among 115 patients, most were young adults (18–30 years, 47%) and male (71.3%). Organophosphorus (OP) compounds were the most common (39.1%), followed by household bleach and paraquat (24.3%). Median ICU stay was 5 days, and hospital stay was 9 days. ICU mortality was 18.3%, with 81.7% surviving to discharge. Gastric lavage was performed in 23.5%, and antidotes in 65.2%, with slightly higher survival among recipients (66% vs. 61.9%). OP poisoning was linked to central nervous and cardiovascular complications, while methanol poisoning was strongly associated with acute kidney injury. Non-survivors had shorter ICU stays, more renal complications, higher vasopressor use (90.5%), and increased need for renal replacement therapy (52.4%). Logistic regression identified longer hospital stay (OR = 1.124, p = 0.044) and vasopressor use (OR = 0.029, 95% CI: 0.005–0.176) as significant mortality predictors.
Conclusion: Poisoning-related ICU admissions mainly affected young males, with OP compounds and methanol as leading toxins. Methanol poisoning and vasopressor requirement were strongly associated with mortality. Early recognition and aggressive management are essential for improving outcomes.
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