Background: The addition of magnesium sulfate (MgSO4) to standard treatment has improved mortality and morbidity associated with organophosphorus compound (OPC) poisoning. We aimed to assess the effectiveness of adjunctive intravenous MgSO4 (IV MgSO4) in poisoning from OPCs. Methods: Forty-seven cases and 72 controls were recruited to this prospective open-label clinician-initiated intervention trial after admitting OPC poisoning. All patients received standard treatment for anticholinesterase poisoning, and oximes were not used. Cases were divided into two groups. Group A (22 patients) received IV MgSO4 at 4 g/day in four divided doses (1 g every 6 h) on day 1. Group B (25 patients) received the same daily dose of IV MgSO4 throughout the hospital stay. Group C (72 patients) represents historical controls who did not receive IV MgSO4. The primary outcome was inhospital mortality. The secondary outcomes included the development of intermediate syndrome (IMS), the requirement of mechanical ventilation (MV), duration of MV, and length of hospital stay. Results: Baseline parameters in both groups were comparable. There is no statistically significant difference in mortality among three groups (Group A: 2/22, 9.1%; Group B: 5/25, 20% and Group C: 6/72, 8.3%). Results were similar for the development of IMS, the requirement of MV, length of MV, and duration of hospital stay. Conclusion: IV MgSO4 did not result in better outcomes compared with standard care alone in OPC poisoning.

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OBJECTIVES: Evaluating local trends and continued monitoring of patterns of acute poisoning are essential for prompt recognition of the toxidromes, the establishment of immediate treatment facilities (e.g., antidote availability), and effective preventive strategies (e.g., governmental regulation on hazardous substances marketing). We aimed to describe the prevalence of the various types of poisoning and associated case fatality in our academic hospital in North India. METHODS: A prospective observational descriptive study was conducted, enrolling patients aged ≥13 years with acute poisoning for 17 months from December 2016 to December 2017 and from September 2019 to December 2019, for a total of 17 months. RESULTS: Four hundred and two patients were enrolled (median age 28 years; 63.2% males). Majority of the acute poisoning cases resulted from ingestion ( n = 391, 97.3%) and the primary intention was most commonly self-harm ( n = 314, 78.1%). The major types of poisoning were pesticide ( n = 264, 65.7%), drug overdose ( n = 77, 19.2%), and corrosive ingestion ( n = 31, 7.7%). Pesticides included insecticides ( n = 146, 36.3%; cholinesterase inhibitors, n = 91), fungicides ( n = 76, 18.9%; all aluminum phosphide), herbicides ( n = 22, 5.5%; paraquat, n = 19), and rodenticides ( n = 20, 5.0%; coumarin-derived substances, n = 12). Benzodiazepines ( n = 33) and opioids ( n = 25) were frequent causes of drug overdose. 95.3% ( n = 379) received preliminary treatment at the previous health-care center, including gastric lavage ( n = 239) and antidotes ( n = 73). In-hospital case fatality rate was 17.3% ( n = 58). CONCLUSION: Herbicide ingestion and opioid overdose are emerging threats with a gradual decline in organophosphate and aluminum phosphide poisoning. Despite improving management of acute poisoning, the overall case fatality rate remains substantial.