Correspondence

Organophosphorus Poisoning in the Kashmir Valley, 1994 to 1997

N Engl J Med 1998; 338:1078-1079April 9, 1998

Article

To the Editor:

An estimated 1 million serious accidental poisonings and 2 million suicide attempts involving organophosphorus compounds occur each year worldwide.1 India ranks second in Asia in annual pesticide consumption.2

We prospectively studied 164 patients (age range, 14 to 58 years) from different districts of the Kashmir valley, who were seen in the casualty department of SMHS Hospital, Srinagar, India, with a history of exposure to organophosphorus compounds between April 1994 and July 1997 (Table 1Table 1Characteristics of 164 Patients with Organophosphorus Poisoning.). Most of the patients (74.4 percent) had consumed these agents to attempt suicide. Phosphamidon was the agent most frequently ingested. Two thirds of the patients lived in districts with large areas of apple orchards. About 90 percent had consumed 5 to 50 ml of various agents; the rest had taken more. About 80 percent were seen within two to four hours. Thirty-eight patients (23.2 percent) initially denied consumption of these agents, though they had clinical features of poisoning. The precipitation factors in the suicide attempts were strained social relations (in 30.3 percent, mainly caused by the death of a close relative in the current political unrest), failure in examinations (20.5 percent), unemployment (18.0 percent), failure in love affairs (14.0 percent), and others (17.1 percent). Nine patients died, and 155 recovered.

Organophosphorus compounds are commonly used as insecticides, pesticides, and fungicides in Kashmir. Since 1990, political unrest has caused great suffering and mental trauma among the residents of Kashmir. The high incidence of organophosphorus poisoning with suicidal intent is but one of many manifestations of the tragic consequences of this unrest.

G.M. Malik, M.D.
M. Mubarik, M.D.
G.J. Romshoo, M.D.
Government Medical College, Srinagar, 190010, Kashmir, India

2 References

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   O'Malley M. Clinical evaluation of pesticide exposure and poisonings. Lancet 1997;349:1161-1166
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   Kishore Gnana Sam, Hira H. Andrade, Lisa Pradhan, Abhishek Pradhan, Shashi J. Sones, Padma G. M. Rao, Christopher Sudhakar. (2008) Effectiveness of an educational program to promote pesticide safety among pesticide handlers of South India. International Archives of Occupational and Environmental Health 81:6, 787-795
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   B.R. Sharma ., Nidhi Relhan ., Neha Gupta ., Harshabad Singh .. (2007) Trends of Fatal Poisoning in Northern India: A Ten-year Autopsy Analysis. Journal of Pharmacology and Toxicology 2:4, 350-358
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   L. London, A.J. Flisher, C. Wesseling, D. Mergler, H. Kromhout. (2005) Suicide and exposure to organophosphate insecticides: Cause or effect?. American Journal of Industrial Medicine 47:4, 308-321
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   Stephanie Garcia, Aqel Abu-Qare, Winifred Meeker-O'Connell, Anita Borton, Mohamed Abou-Donia. (2003) Methyl Parathion: A Review of Health Effects. Journal of Toxicology and Environmental Health, Part B 6:2, 185-210
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   L. Karalliedde. (1999) Organophosphorus poisoning and anaesthesia. Anaesthesia 54:11, 1073-1088
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