Poisoning Scenario Developed vs Developing countries Poisoning scenario in developed countries is quite different from developing countries. Case fatality with pesticides in developing countries is 10-30% compared to 0.5-1% with drugs in developed countries. Intentional self-poisoning with pesticides is an important public health problem in the Asia- Pacific region with an estimated 300,000 deaths occurring each year.

Possible reasons for Clinical Toxicology remaining a neglected and Orphan Discipline in India In India, there are few takers for toxicology and treatment of poisoning is often arbitrary and follows obsolete practices. Clinical toxicology is not a lucrative branch like other branches of medicine Teaching of clinical toxicology is fragmented in spite of the fact that every hospital sees poisoning cases on a daily basis.

Possible reasons for Clinical Toxicology remaining a neglected and Orphan Discipline in India Majority of the poisonings are suicidal and in our society this carries a social stigma due to medico legal aspects There is a lot of unethical practice in handling of poisoning cases Unlike communicable diseases, there is no reporting system for poisoning Toxicology is often discussed by Critical Care Specialists in tertiary care hospitals and the guidelines they recommend are not applicable at the Primary Care level

Some Modest Efforts by CEARCH CEARCH provides 1. Toxicology services (only to Physicians) - Telephonic information and Consultation - Toxicological analysis and lab support in emergencies Plasma and RBC Cholinesterase levels, Urine drug screens, Identification of unknown substances in Gastric lavage and urine samples Blood levels of Paracetamol, Salicylates, Phenobarbitone and Methemoglobin

Services provided by CEARCH Teaching in Toxicology for physicians and paramedical staff In collaboration with GVK EMRI (108) Gujarat State Disaster Management Authority (GSDMA) Indian Red Cross Society (Gujarat State)

Some of the observations from cases referred to CEARCH Pesticide poisonings remain commonest, Mortality varies not only with type of pesticide but also who treats the patient Drug poisonings are quite common e.g. sedatives, analgesics, OTCs, Acute Methemoglobinemia due to dye intermediates, drugs Lead poisonings due to Ayurvedic medicines common Knowledge of clinical toxicology still remains minimal

What we need in India ! Need for awareness about poisoning and toxicology at all levels, Doctors, Paramedical, Health authorities Regular Teaching in Clinical Toxicology as a part of medical curriculum Poison Information Centres There is a dire need to strenghten Poison Information services in the country