Study of clinical profile and outcome of acute kidney injury in acute poisoning and envenomation

Abstract

Background: Envenomation and poisonings can cause renal damage by number of mechanisms. Some of them may cause rhabdomyolysis or hemolysis, thereby leading pigment induced renal injury. Other contributory factors like shock, sepsis can also cause acute kidney injury (AKI). The study was done with the aim to evaluate the clinical profile and outcome of acute kidney injury in acute poisoning and envenomation and to find the relationship between early anti serum venom (ASV) administration and early presentation to tertiary care and outcome.Methods: This prospective observational study carried out on 50 patients with history of envenomation and poisoning after meeting the requirements of inclusion criteria. History, examination findings and investigations results were collected and analysed.Results: The incidence of AKI in envenomation and poisoning patients was 5.62%. Majority of the toxin induced AKI were due to the poisoning constitutes about 62%. Among them, paraquat (n=15) was the most common poison. snake bites were the commonest to cause AKI in the envenomation group (n=17). The average time between the event and arrival to hospital was 31 hours. Whereas in case of died patients, the average time between the event and arrival to hospital was about 59 hours. The mean time interval between poison consumption to ASV administration in recovered cases was 6.6 hours and in death cases it was 15 hours. Dialysis requirement was in about 43 (86%) patients. Of them 37 patients underwent hemodialysis (HD). 6 patients underwent peritoneal dialysis (PD). Total number of deaths in the study was 26 and the most common cause was respiratory failure (38.5%).Conclusion: The present study suggests the most common cause of AKI in case of envenomation was snake bite and in case of toxin it was paraquat poisoning. Hence it is necessary to take initiative by the government to increase the facilities in primary health care centers to save the lives of the affected people and to impose restrictions on the availability of poisonous substances in the market.