(072) To Analyze the Utilization Pattern of Antidotes in Poisoned Patients in a Tertiary Care Hospital

Publication Number: 735

Background: Antidotes are substances that aid in counteracting the effects or preventing the action of poisons in the human body. Regular evaluation of the use of antidotes with respect to clinical use, cost effectiveness and availability will help in gaining a better understanding of the antidote utilization pattern and help to improve patient care by ensuring that antidotes are administered rationally and economically.

Objectives: To analyze the utilization pattern of antidotes in poisoned patients in a tertiary care teaching hospital

Methods: A prospective observational study was conducted at the Department of Emergency Medicine in a tertiary care teaching hospital. The collected data was reviewed independently by the intervening pharmacist to analyze the appropriateness of the antidotes prescribed according to the poison protocols, Poisindex, Micromedex, and Toxbase. Data was analyzed using descriptive statistical methods such as percentage analysis, Chi square test of independence, non-parametric bivariate Spearman's rank correlation coefficient test and multiple logistic regression analysis in Statistical Package for the Social Sciences .

Results: Out of the 117 patients, 71 (60.68%) patients were admitted with cases of suicidal poisoning, and were found to have a 24 fold higher chance of suffering from severe poisoning than other types of poisoning (OR=25.79, 95% CI= 1.18 – 56.45, P=0.039). Pesticides were the most implicated agents in poisoning, constituting 44 (37.6%) of the total cases. Antidotes were used in 82 of the poisoning cases. Atropine was the most widely used antidote in 30 (36.85%) patients used for treating organophosphate poisoning followed by anti-snake venom (ASV) in 15 (18.29%) cases to treat snake bite and magnesium sulphate in 12 (14.63%) cases to treat zinc and aluminium phosphide poisoning. Intravenous (IV) was the most common route of antidote administration (51.21%). In 70 (85.36%) patients, antidote was given according to the hospital poison protocol and was justified. The antidotes used in 77 (93.9%) patients were included in NLEM 2015 and in 15 (18.29%) cases a cheaper alternative of the antidote could have been prescribed. After therapy, 93 (79.48%) patients were discharged post recovery.

Conclusions: With the large number of poisoning cases received daily in emergency departments, prompt and effective use and administration of antidotes can prevent significant morbidity and mortality in patients. Thus, awareness programs for HCPs in relation to poisoned patients in either emergency or critical care can be used to update the current directory of information regarding antidote utilization.