Survival Benefits of N-Acetylcysteine in Rodenticide Poisoning: Retrospective Evidence from an Indian Tertiary Care Setting

(E-pub Ahead of Print)

Author(s): Karen Mark, Shabnam Hyder, Muhammed Rashid, Viji Pulikkel Chandran, Shubha Seshadri, Sneha Seshadri, Sreedharan Nair, Girish Thunga*

Journal Name: Current Clinical Pharmacology

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Rationale & Objective: Rodenticide poisoning, either accidental or intentional, is very common in rural India. Absence of a definite antidote made it a major concern with a high mortality rate. So, we aimed to assess the effectiveness of N-Acetyl Cysteine (NAC) in rodenticide poisoning as there are recent positive shreds of evidence on it.

Methodology: A retrospective study was conducted in an tertiary care teaching hospital on patients admitted with rodenticide poisoning during a period of 2012- 2017. The Fischer’s exact test and relative risk were measured to analyse the outcome of treatment and risk factors, respectively.

Results: A total of 229 patients were enrolled in the study with a mean age of 30.04 ± 15.67 years. The suicidal attack was the major (86.0%) reason for poison consumption. The survival rate was significantly (p ≤ 0.03) higher in the NAC treatment group compared to the non-NAC group. Moreover, the majority (93.4%) of participants didn’t experience any adverse effects. The mean oral loading dose and maintenance dose was 7580.95 ± 2204.29 mg and 3694.53 ± 2322.58 mg, respectively. Yellow Phosphorus poisoning (Relative Risk [RR] 2.888 ((1.179-7.079); p=0.020) and Time lag ≥ 24 hours (RR 3.479 (1.137-10.645); p=0.029) were the significant risk factors for mortality.

Conclusion: NAC is shown to have a significant survival benefit with good safety profile among the rodenticide poisoners. Further, adequately powered prospective researches with more emphasis on dosing parameters are warranted for better quantification in different settings and for clinical implementation.

Keywords: Rodenticides, poisons, N-acetylcysteine, toxicology, antidotes, efficacy

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(E-pub Ahead of Print)
DOI: 10.2174/1574884715666200513090634
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