Table 5.

Overview of commonly used poisons in Pakistan

Poison	Symptoms	Diagnosis	Management	Lethal dose	Mortality	Regional prevalence	Cost
Organophosphates	Bronchorrhea, bronchoconstriction, excessive sweating, constricted pupils, abdominal cramps, involuntary defaecation and urination, tachycardia, QT prolongation, headaches, dizziness, drowsiness, confusion, anxiety, slurred speech, ataxia, psychosis, convulsions, coma, hypotension and respiratory depression	Clinical	Supportive care; decontaminate the patient and prevent further absorption via the gut, eyes, skin or lungs; administer atropine followed by enzyme reactivation by pralidoxime	Depends on many factors	10–27%	All over Pakistan, but more prevalent in North Punjab and Sindh	1200–1600 PKR per litre
Aluminium phosphide	Epigastric pain, vomiting, diarrhoea, dizziness and dyspnoea, multiorgan failure involving the heart, kidneys, lungs and liver	Silver nitrate test	Supportive care as no antidote is available; gastric lavage with potassium permanganate and mineral or coconut oil; renal replacement therapy in the early stage may be helpful	150–500 mg	33–87%	North Punjab	700–1000 PKR per 500 mg
Paraphenylenediamine	Angioneurotic oedema, rhabdomyolysis causing myoglobinuria, cola-coloured urine, oliguria and acute tubular necrosis leading to acute renal failure	Clinical	Supportive care as no antidote is available; early tracheostomy; intravenous fluids to prevent renal failure; renal replacement therapy in cases where ATN develops	7–10 g	21–47%	South Punjab and South KPK	500 PKR per 10 g
Over-the-counter agents and household chemicals	May present with CNS depression, CNS stimulation or a mixed picture; the heart rate, blood pressure, body temperature, respiratory rate, skin clamminess, pupillary reaction and neuromuscular abnormalities would provide clues to the correct diagnosis	Clinical	Supportive care; decontamination and gastric lavage with activated charcoal antidote (flumazenil for benzodiazepines) should be used if available; haemodialysis, haemofiltration and exchange transfusion could facilitate the removal of some agents	Depends on agent used	2.5–25%	Urban areas	Diazepam is one of the most commonly used benzodiazepines; it is 37 PKR for 30 10-mg tablets

ATN, acute tubular necrosis; KPK, Khyber Pakhtunkhwa; CNS, central nervous system.