Clinical profile and evolution of acute poisoning cases in a public hospital in Ica, Peru

Clinical profile and evolution of acute poisoning cases in a public hospital in Ica, Peru Eddie Loyola-Gonzales1, Josefa Bertha Pari-Olarte1, José Francisco Kong-Chirinos1, Javier Hernán Chávez Espinoza1, Donato Efrain Ambia Pereyra1, Cristina Esther Uribe Rosas1, Freddy Emilio Tataje Napuri1, Luis Alberto Pecho Tataje1, Victor Hernán Elías Yupanqui1, José Santiago Almeida Galindo1 1 National University San Luis Gonzaga, Ica, Peru Corresponding author: Eddie Loyola-Gonzales (eddie.loyo[email protected]) Received 9 April 2025♦ Accepted 7 December 2025♦ Published 23 December 2025 Citation: Loyola-Gonzales E, Pari-Olarte JB, Kong-Chirinos JF, Chávez Espinoza JH, Ambia Pereyra DE, Uribe Rosas CE, Tataje Napuri FE, Pecho Tataje LA, Elías Yupanqui VH, Almeida Galindo JS (2025) Clinical profile and evolution of acute poisoning cases in a public hospital in Ica, Peru. Pharmacia 72: 1–15. https://doi.org/10.3897/pharmacia.72.e155405 Abstract Cases of acute poisoning represent a serious public health problem in developing countries, where 90% of poisoning-related deaths occur. In Peru, epidemiological information on these cases in public hospitals is limited. Strengthening drug surveillance and implementing poison control centres are key to improving case detection and reporting in hospital emergencies. This study aimed to describe the epidemiological characteristics of acute poisoning cases treated in the emergency department of a referral hospital in Ica, Peru, between January 2022 and June 2024 (Table 3). An observational, descriptive, and retrospective study was conducted by analysing variables from admission records and patient medical records. A total of 207 cases were analysed, with a predominance of women (53.1%) and young adults (45.4%), with an average age of 24.3 years. The six-monthly incidence was 26 cases per 10,000 hospital admissions. Most patients were single (66.7%) and had a secondary education (68.1%). The most frequent cases of poisoning were due to psychotropic drugs (25.6%) and pesticides (23.2%), with intentional causes at 62.8%, particularly suicide attempts. Most cases had a mild to moderate course, with hospital stays of 12 to 24 hours. No deaths were recorded. It is concluded that cases of poisoning primarily affect young women, with a significant association between aetiology and case severity. Keywords Acute poisoning, epidemiology, public health, public hospital, toxicovigilance Introduction Acute poisoning is a public health problem and one of the leading causes of emergency department admissions worldwide. Although clear preventative measures are required, few studies address its epidemiological and clinical characteristics. It is a leading cause of morbidity and mortality worldwide, with 90% of fatal poisoning cases originating in developing countries. In developed countries, the mortality rate from poisoning is 1% to 2%, but in developing countries, it can be as high as 20% (Ministry of Health 2016). In Peru, an increase in acute poisoning care requiring emergency services has been reported since 1950, generally representing around 1% to 2% of all emergencies attended. Of these, chemical poisoning is a major cause of morbidity and disability (Ministry of Health 2016). This situation is no different in Ica, a Peruvian region characterised as an emerging geographic area with significant agricultural Copyright Loyola-Gonzales E et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pharmacia 72: 1–15 DOI 10.3897/pharmacia.72.e155405 Review Article Loyola-Gonzales E et al.: Antibiotic Use and Microbial Resistance Threat in a Peruvian Public Hospital2 export activity, implying the need for reliable information on the toxic agents most involved in acute poisoning, their risk of exposure, and their best diagnosis and treatment. One of the key points where this information can be obtained is hospital emergency services, where most toxic clinical conditions are treated, representing the most reliable sources of data for information on these cases (Pan American Health Organization 2012). Some of the studies on the epidemiology of acute poisonings in this Peruvian region indicate that, by production mechanism, the most frequent poisonings are accidental poisonings by domestic products and self-administered poisonings by agricultural products, the former affecting mainly children and the latter adults, and amongst pesticide poisonings, organophosphate insecticides and carbamates are the most reported, mostly associated with accidental exposures (Chavez 2016b; Chávez and Castillo 2022). In the absence of a standardised toxicological–epidemiological registry and, above all, given the fact that the variables analysed do not have a clinical indicator in most studies, it is of interest to address this research problem in a public hospital in this region, as a sentinel site for recording and reporting cases of acute poisoning. At the international level, several authors have investigated the profile and evolution of acute poisoning cases in different regions. In Egypt, rodenticides were identified as the most common agents (Rageh et al. 2023) with a mortality rate of 4%, higher in intentional poisonings (Aggarwal et al. 2023). In India, a mortality rate of 16.3% has been reported, with snakebites and pesticides as the main causes. George et al. (2023), also in India, highlighted a high incidence of organophosphate pesticide poisoning, with a mortality rate of 4.2%. Liu et al. (2023), in China, reported an increase in suicide attempts due to poisoning starting in 2020, with drugs and pesticides as the most common causes (Waktola et al. 2023). In Ethiopia, a high prevalence of adverse outcomes in acute poisoning (17.6%) was identified, associated with comorbidities (George et al. 2023; Liu et al. 2023; Reda et al. 2023; Waktola et al. 2023). In addition, in Ethiopia, a mortality rate of 18% was reported, associated with a rural origin and lack of triage care (Beigh et al. 2023). In Saudi Arabia, drugs were identified as the main cause of poisoning, affecting mainly children (Al-Daghastani and Naser 2022). In England, an increase in hospitalisations due to psychotropic poisoning was observed, correlated with an increase in prescriptions of central nervous system (CNS) medications. In India, a 15% mortality rate was reported, with snakebites and pesticides as the most common causes, as well as a prevalence of intentional poisoning of 57.5%, with corrosives and pesticides being the main agents (Chatterjee et al. 2020; Mathew et al. 2021). Similarly, at the national level in Peru, various studies have investigated the characteristics and evolution of acute poisoning cases. A retrospective study of children under 18 years of age found that household products, such as rodenticides, were the main agents implicated, with 78.1% of cases presenting a cholinergic syndrome, in addition to a high correlation between sex and the type of poisoning. Cases of acute poisoning evaluated at the Cajamarca Regional Hospital between 2012 and 2018 found that ethyl alcohol was the most common agent, and 11 deaths were reported. Forty-two cases of acute poisoning in children were identified at the Cajamarca Regional Hospital during 2018, with food poisoning being the most frequent, with the majority of cases being accidental. A study of 147 cases of suicide attempts due to organophosphate pesticides was conducted at the Cusco Regional Hospital, identifying a predominance in young women with a secondary education and a mortality rate of 0.7%. A total of 164 cases of attempted suicide were reported in adolescents at the III Goyeneche Hospital in Arequipa between 2013 and 2017, with a higher incidence in women and a prevalence of family dysfunction as an associated psychiatric co-morbidity (Puma 2018; Huaylla 2019; Huamán 2019; Díaz 2022; Yñigo 2023). At the local level, the results of epidemiological surveillance of pesticide poisoning in Ica were analysed between 2016 and 2021, identifying a high incidence in women, with anti-cholinesterase pesticides as the most implicated. A review of 1,281 cases of acute pesticide poisoning in Ica during 2016–2021 found that most cases were accidental and mild, with a case fatality rate of 0.16%. Finally, 1,940 cases of poisoning were identified in Ica between 2012 and 2016, with drugs, pesticides, and ethyl alcohol being the most common agents, with intentional aetiology predominating (Chavez 2016a; Castilla 2022; Chávez and Castillo 2022). It is worth noting that acute poisoning internationally, particularly involving pesticides such as organophosphates, is emerging as one of the most frequent causes of poisoning, especially in countries such as India and China. There is also an increase in poisoning cases related to suicide attempts, especially amongst young women. Intentional poisonings are frequent, while accidental poisonings, often related to handling toxic substances at home or at work, are also significant. In rural areas, exposure to poisons and pesticides is common, and mortality rates can be high, especially when there is a lack of access to timely medical care. At the national level, studies paint a similar picture, with household products, such as rodenticides and ethyl alcohol, as the predominant causes in certain population groups. Accidental poisonings are more common in children and adolescents, while intentional poisonings are more prevalent in young adults. Mortality rates in these studies tend to be lower compared with international contexts, although concerns remain about the impact of suicide attempts and gaps in surveillance and care systems. Overall, cases of acute poisoning represent a significant public health problem in both contexts. Intentional poisonings and improper handling of hazardous substances contribute to the high prevalence of these cases. Timely intervention and improved epidemiological and mental health surveillance systems are crucial for reducing serious outcomes associated with acute poisoning. In this sense, this research, in response to the growing concern about cases of acute poisoning at the national and international levels, seeks to lay the foundations for Pharmacia 72: 1–15 3 the creation of a toxicological observatory that will allow for systematic monitoring of acute chemical poisoning cases in order to generate valid and reliable information. This information, once disseminated through the relevant channels of the region’s health institutions, will facilitate the implementation of health prevention and protection measures, especially amongst vulnerable populations, such as children, pregnant women, older adults, and people with psychiatric disorders. In addition to its cognitive relevance, which will allow for a better understanding of the social and environmental determinants of these poisonings, the study is of academic importance as it offers findings that can be shared with researchers in toxicovigilance, strengthening epidemiological surveillance in public health. Finally, given its social relevance, which lies in promoting active surveillance of acute poisoning, it seeks to contribute to compliance with the General Health Law and foster collaboration between the State, society, and individuals to protect the health of the population. Finally, the interpretation of the results will be essential for drug surveillance, as it will allow for the establishment of practical recommendations in various areas. In the clinical setting, they can improve the identification and treatment of acute poisoning; in the domestic sector, they will contribute to prevention through education on the safe handling of chemical substances; in the occupational sector, they will guide protective measures for workers exposed to toxic products; and in the environmental sector, they will help mitigate community exposure to contaminants. Furthermore, in the forensic field, the results will be valuable in clarifying poisoning cases with legal implications. Methodological strategy Design and population This research is of a basic nature, as its objective was to expand scientific knowledge about acute poisoning and generate a theoretical basis to facilitate future research. The study is descriptive in nature, focusing on characterising the cases of acute poisoning that occurred during the study period. It uses a non-experimental design with a quantitative approach and an ambispective approach, incorporating both retrospective and prospective aspects. The study population consisted of the medical records of all patients admitted to the emergency department of a public hospital in the Peruvian region of Ica between 1 January 2022 and 30 June 2024, with a diagnosis of acute chemical poisoning. It was decided not to perform sampling but instead to collect data on all recorded poisoning cases to maximise the accuracy of the results. The following inclusion and exclusion criteria were applied: • Inclusion criteria: - Medical records of patients of both sexes and any age, with a clinical diagnosis of acute poisoning by chemical agents. - Medical records available in the hospital archive and with complete data. - Medical records of patients diagnosed with acute poisoning in the emergency department between 1 January 2022 and 30 June 2024. • Exclusion criteria: - Clinical histories of cases of acute poisoning by biological toxins (e.g. snake venom, scorpion venom, marine toxins) and physical agents. When medical literature refers to intoxications caused by biological toxins, it does not exclusively imply pathogenic microorganisms or infections. It also encompasses envenomations and poisonings resulting from animal secretions or naturally derived toxic metabolites, which are of significant clinical and public health concern due to their prevalence in endemic regions and the complexity of their therapeutic management. - Medical records not found in the hospital archives. - Medical records with incomplete information. Procedure Data were collected using systematic observation techniques and documentary analysis, using the medical records of the patients included in the study, with prior authorisation from the competent hospital authorities. Eight variables from the emergency department admission records were considered for the study: sex, age, place of origin, date and time of admission, date and time of discharge, service of origin, discharge status, and initial diagnosis. Fourteen other variables were taken from the medical records: marital status, education level, place of birth, duration of illness, onset and end of the disease, toxic agent involved, emergency severity scale, referral process, diagnostic impression of the referral, decontamination, antidote administration, personal history, and ICD-10 discharge diagnoses. These variables, in turn, can be classified into sociodemographic and clinical variables. Two instruments were used for data collection: the Emergency Department Admission Book Data Collection Form (Annex 1) and the Medical History Data Collection Form (Annex 2). Both instruments contain the operational elements of the study variables. The Medical History Data Collection Form was adapted from the Public Health Epidemiological Research Sheet on the risk of pesticide exposure and poisoning, published by the National Center for Epidemiology, Disease Prevention and Control of the General Directorate of Epidemiology of the Ministry of Health of Peru (Ministry of Health 2016). Data collection was conducted in the emergency department by reviewing the Emergency Department Admission Booklet Data Collection Form to identify cases diagnosed as acute chemical poisoning. Subsequently, the medical records of the identified cases were requested from the hospital’s Statistics and Information Technology Loyola-Gonzales E et al.: Antibiotic Use and Microbial Resistance Threat in a Peruvian Public Hospital4 Office, where the Medical History Data Collection Form was administered. In the emergency department admission records, 268 cases of acute poisoning were identified during the study period; however, 31 medical records were not located in the central file, and another 30 were incomplete, so it was not possible to collect information on the care provided to these cases of poisoning or exposure to chemical agents. The study complied with the guidelines established by the Council for International Organisations of Medical Sciences (CIOMS) and the codes of ethics of the National University of San Luis Gonzaga and the Regional Hospital of Ica. The information was handled under strict confidentiality, and no personal data, medical history, clinical diagnoses, or intimate patient information was disclosed. Since the study did not involve direct interaction with the subjects, it was not necessary to obtain informed consent from the patients. Results Sociodemographic and medical characteristics During the toxicovigilance period, from 1 January 2022 to 30 June 2024, a total of 268 cases of acute poisoning by chemical agents were recorded. However, of these cases, 207 medical records (77.2% of the total) were retrieved for data collection, implying that approximately one-fifth of the cases (22.8%) resulted in data loss. Regarding incidence, the highest six-monthly rate was observed in the first half of 2023 (31.1 cases per 10,000 admissions), while the lowest was recorded in the first half of 2024 (24 cases per 10,000 admissions), with a mean six-month incidence of 26.3 acute poisonings per 10,000 hospital admissions. This finding suggests the need to analyse the contextual and specific factors that could influence the variability observed in poisoning rates at six months. (Table 1) During the study period, of the total number of clinical histories evaluated (207 cases of acute chemical poisoning), a higher frequency was found in female patients (53.1%) than in males (46.9%). Regarding age, cases were mainly concentrated in the 18–29 age group (45.4%), with women in this group being the most affected (28.5%). In second place was the adult group aged 30–59 (25.6%), with a higher proportion of men (16.9%) compared to women (8.7%). The groups of children (0–11 years) and adolescents (12–17 years) represented 14.5% and 11.6%, respectively, also reflecting a greater impact on young women and adolescents in this poisoning profile. The elderly group (60 years and older) had the lowest incidence, with only 2.9% of the total cases, distributed equally between both sexes. The average age in all cases was 24.23 years (± 14.28), but according to sex, it was 25.87 (± 15.15) in men and 22.79 (± 13.37) in women. The median age was 23 years overall, 25 years in men, and 23 years in women (Table 2). Figs 1, 2 show the variation in patient age by sex and semester, highlighting that, as mentioned, most cases were concentrated in the younger population (18 to 29 years). Table 1. Semi-annual distribution of acute chemical poisoning cases in a public hospital in Ica, Peru (January 2022 to June 2024). Cases recorded as acute poisoning 2022 2023 2024 Total Week I Week II Week I Week II Week I n (%) n (%) n (%) n (%) n (%) n (%) Complete medical history 38 (82.6) 54 (81.8) 38 (74.6) 42 (67.8) 35 (81.4) 207 (77.2) Incomplete medical history 5 (10.9) 4 (6.1) 9 (17.6) 10 (16.1) 2 (4.7) 30 (11.2) Medical records not located on file 3 (6.5) 8 (12.1) 4 (7.8) 10 (16.1) 6 (14.0) 31 (11.6) Total cases 46 (17.2) 66 (24.6) 51 (19.0) 62 (23.1) 43 (16.0) 268 (100.0) Total income 17865 24975 16396 24830 17902 101968 Incidence per 10,000 admissions 25.7 26.4 31.1 25.0 24.0 26.3 Note. Source: Own elaboration. Figure 1. Age distribution of the patients in relation to sex during the follow-up period of acute poisoning. Figure 2. Age distribution of the patients in relation to the sixmonth follow-up of acute poisoning. Pharmacia 72: 1–15 5 Table 3 presents a detailed analysis of the sociodemographic and medical variables of the cases evaluated at the sentinel hospital for follow-up. The distribution of acute chemical poisoning cases treated in the emergency department of a public hospital in Ica between January 2022 and June 2024 reveals specific demographic and medical patterns: 53.1% of those affected were women, while 46.9% were men, marking an insignificant difference by sex. However, regarding age, it is evident that the majority of cases correspond to young people (45.4%) and adults (25.6%), followed by children (14.5%) and adolescents (11.6%), with older adults being the least affected group (2.9%). Regarding marital status, single patients predominate (66.7%), while married or cohabiting individuals represent a smaller proportion of cases. Regarding education, the majority of patients had completed secondary school (68.1%), while only 13.0% had higher education and 4.4% had only primary education. Regarding their place of origin, 63.29% of patients were from urban areas and 36.71% from rural areas. Most patients were born in the Ica Region (83.6%), with a small percentage born in other regions of Peru (15.4%) or abroad (1.0%). Finally, the clinical history revealed that 27.5% had a history of pathological disorders and 13.5% had a history of suicidal behaviour. Other less common histories included harmful habits (6.3%) and previous Table 2. Semi-annual distribution of cases of acute poisoning by chemical agents in a public hospital in Ica, Peru (January 2022 to June 2024) according to sex and age group. Semester/ age group Women Men Total n%n%n% 2022-I 20 9.7 18 8.7 38 18.4 Child (0–11 years) 3 1.4 4 1.9 7 3.4 Teenager (12–17 years) 3 1.4 2 1.0 5 2.4 Young (18–29 years old) 10 4.8 5 2.4 15 7.2 Adult (30–59 years) 4 1.9 6 2.9 10 4.8 Senior citizen (60 years or older) 0 0.0 1 0.5 1 0.5 2022-II 30 14.5 24 11.6 54 26.1 Child (0–11 years) 2 1.0 5 2.4 7 3.4 Teenager (12–17 years) 8 3.9 1 0.5 9 4.3 Young (18–29 years old) 18 8.7 11 5.3 29 14.0 Adult (30–59 years) 2 1.0 7 3.4 9 4.3 Senior citizen (60 years or older) 0 0.0 0 0.0 0 0.0 2023-I 22 10.6 16 7.7 38 18.4 Child (0–11 years) 5 2.4 1 0.5 6 2.9 Teenager (12–17 years) 5 2.4 2 1.0 7 3.4 Young (18–29 years old) 10 4.8 9 4.3 19 9.2 Adult (30–59 years) 2 1.0 4 1.9 6 2.9 Senior citizen (60 years or older) 0 0.0 0 0.0 0 0.0 2023-II 22 10.6 20 9.7 42 20.3 Child (0–11 years) 1 0.5 4 1.9 5 2.4 Teenager (12–17 years) 2 1.0 0.0 2 1.0 Young (18–29 years old) 10 4.8 4 1.9 14 6.8 Adult (30–59 years) 7 3.4 10 4.8 17 8.2 Senior citizen (60 years or older) 2 1.0 2 1.0 4 1.9 2024-I 16 7.7 19 9.2 35 16.9 Child (0–11 years) 1 0.5 4 1.9 5 2.4 Teenager (12–17 years) 0.0 1 0.5 1 0.5 Young (18–29 years old) 11 5.3 6 2.9 17 8.2 Adult (30–59 years) 3 1.4 8 3.9 11 5.3 Senior citizen (60 years or older) 1 0.5 0 0.0 1 0.5 Total 110 53.1 97 46.9 207 100.0 Child (0–11 years) 12 5.8 18 8.7 30 14.5 Teenager (12–17 years) 18 8.7 6 2.9 24 11.6 Young (18–29 years old) 59 28.5 35 16.9 94 45.4 Adult (30–59 years) 18 8.7 35 16.9 53 25.6 Senior citizen (60 years or older) 3 1.4 3 1.4 6 2.9 Average 22.79 25.87 24.23 Standard deviation 13.376 15.152 14.284 Note. Own elaboration. Loyola-Gonzales E et al.: Antibiotic Use and Microbial Resistance Threat in a Peruvian Public Hospital6 chemical exposure (2.4%). The clinical history reported by the patients included self-medication, consumption of psychoactive substances (alcohol, marijuana, chlorobenzylpiperazine), psychiatric and behavioural disorders (anxiety, depression, bipolar personality, schizophrenia, anorexia, bulimia), chronic non-communicable diseases (hypertension, asthma, diabetes, gastritis), surgical interventions (appendectomies, caesarean sections), previous accidental exposure to chemicals (pesticides), adverse reactions to medications, and a history of suicidal behaviour (psychotic symptoms with suicidal ideation, previous suicide attempts by chemical agents, self-harm by sharp agents, jumping from high places). Although some six-monthly variations are observed in certain groups, they do not appear to indicate significant changes or marked trends in the incidence of poisoning, taking into account the sociodemographic and medical characteristics considered. Table 3. Distribution of acute chemical poisoning cases according to sociodemographic and medical characteristics of patients treated in the emergency department of a public hospital in Ica, Peru (January 2022 to June 2024). Variables - Indicators 2022-I 2022-II 2023-I 2023-II 2024-I Total n (%) n (%) n (%) n (%) n (%) n (%) Sex Women 20 (9.7) 30 (14.5) 22 (10.6) 22 (10.6) 16 (7.7) 110 (53.1) Man 18 (8.7) 24 (11.6) 16 (7.7) 20 (9.7) 19 (9.2) 97 (46.9) Age Child 7 (3.4) 7 (3.4) 6 (2.9) 5 (2.4) 5 (2.4) 30 (14.5) Teenager 5 (2.4) 9 (4.3) 7 (3.4) 2 (1.0) 1 (0.5) 24 (11.6) Young 15 (7.2) 29 (14.0) 19 (9.2) 14 (6.8 17 (8.2) 94 (45.4) Adult 10 (4.8) 9 (4.3) 6 (2.9) 17 (8.2) 11 (5.3) 53 (25.6) Senior citizen 1 (0.5) 0 (0.0) 0 (0.0) 4 (1.9) 1 (0.5) 6 (2.9) Marital status Single 23 (11.1) 43 (20.8) 27 (13.0) 23 (11.1) 22 (10.6) 138 (66.7) Cohabitant 5 (2.4) 3 (1.4) 4 (1.9) 8 (3.9) 5 (2.4) 25 (12.1) Married 3 (1.4) 1 (0.5) 1 (0.5) 6 (2.9) 3 (1.4) 14 (6.7) Not applicable 7 (3.4) 7 (3.4) 6 (2.9) 5 (2.4) 5 (2.4) 30 (14.5) Level of education Primary 1 (0.5) 4 (1.9) 3 (1.4) 1 (0.5) 0 (0.0) 9 (4.4) High school 26 (12.6) 36 (17.4) 24 (11.6) 29 (14.0) 26 (12.6) 141 (68.1) Superior 4 (1.9) 7 (3.4) 5 (2.4) 7 (3.4) 4 (1.9) 27 (13.0) Not applicable 7 (3.4) 7 (3.4) 6 (2.9) 5 (2.4) 5 (2.4) 30 (14.5) Place of origin Urban 25 (12.08) 35 (16.91) 20 (9.66) 25 (12.08) 26 (12.56) 131 (63.29) Rural 13 (6.28) 19 (9.18) 18 (8.70) 17 (8.21) 9 (4.35) 76 (36.71) Place of birth Ica Region 32 (15.5) 39 (18.8) 32 (15.5) 39 (18.8) 31 (15.0) 173 (83.6) Another region 6 (2.9) 13 (6.3) 6 (2.9) 3 (1.4) 4 (1.9) 32 (15.4) Another country 0 (0.0) 2 (1.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (1.0) Medical history No reference 20 (9.7) 27 (13.0) 20 (9.7) 14 (6.8) 23 (11.1) 104 (50.3) Bad habits and risk factors 2 (1.0) 2 (1.0) 4 (1.9) 2 (1.0) 3 (1.4) 13 (6.3) Pathological history 7 (3.4) 19 (9.2) 9 (4.3) 15 (7.2) 7 (3.4) 57 (27.5) History of chemical exposure 3 (1.4) 2 (1.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (2.4) History of suicidal behaviour 6 (2.9) 4 (1.9) 5 (2.4) 11 (5.3) 2 (1.0) 28 (13.5) Note. Own elaboration. Clinical features According to the aetiology of the poisonings, a higher prevalence was found in intentional poisonings. These comprised 62.8% of cases, with the most common cause being suicide poisoning (57.5% of the total). Poisoning due to assault or homicide did not register any cases during the study period. Accidental poisoning accounted for 37.2% of cases, with a somewhat homogeneous distribution across the six-month periods. Accidental poisonings included those of incidental origin (24.6%), iatrogenic origin (1.9%), and occupational origin (1.5%). Regarding the toxic substances involved, substances of primarily non-medicinal origin were the most associated with poisoning or acute exposures, representing 59.4% of all cases. A high percentage of these were pesticides (23.2%), followed by abuse of drugs such as alcohol, marijuana, cocaine base paste, and cocaine (11.1%), household products (corrosive substances) (10.1%), and animal venom (8.7%). Medicinal toxins accounted for 40.6% of poisonings, with psychotropic drugs being the most common type (25.6%). Most cases were observed within the first 1 to 2 hours after exposure (51.2%), indicating an early response by patients to hospitalisation. Only 20.8% had a delay of more than 4 hours. Furthermore, the oral route was the most frequently involved (82.1%), consistent with the frequency of accidental or suicidal poisoning. Other routes, such as cutaneous and respiratory, were less frequent (9.7% and 7.7%, respectively). The former was mainly associated with traumatic contact with poisonous animals (snakes and spiders), and the latter with occupational exposure to pesticides or accidental exposure to smoke. Pharmacia 72: 1–15 7 In 58.0% of cases, no decontamination was required. When performed, gastric lavage was the most commonly used technique in cases of chemical ingestion (41.0%). Antidote administration was limited, given the nature of the toxins involved in the poisonings and the medical evaluation, with atropine being the most commonly used antidote (13.53%), as it is associated with the treatment of anti-cholinesterase pesticide poisoning (Table 4). Table 5 shows the distribution of acute chemical poisoning cases according to the aetiology, sex, and age group of patients seen in the emergency department. Amongst accidental poisoning, incidental poisoning is the most frequent, accounting for 24.6% of cases. Incidental poisoning, with 51 cases (21 women and 30 men), represents the second largest aetiology group and mainly affects children and adolescents, with no significant sex difference according to the chi-square test (χ² = 5.030; p = 0.284). Iatrogenic poisoning shows a lower distribution (4 cases), with a significant difference between sexes (χ² = 4.000; p = 0.046), affecting mainly young people and adults, with a higher Table 4. Distribution of acute chemical poisoning cases according to the clinical characteristics of patients treated in the emergency department of a public hospital in Ica, Peru (January 2022 to June 2024). Variables - Indicators 2022-I 2022-II 2023-I 2023-II 2024-I Total n (%) n (%) n (%) n (%) n (%) n (%) Etiology Accidental 15 (7.2) 18 (8.7) 9 (4.3) 16 (7.7) 19 (9.2) 77 (37.2) incidental 9 (4.3) 12 (5.8) 8 (3.9) 12 (5.8) 10 (4.8) 51 (24.6) Iatrogenic 0 (0.0) 0 (0.0) 1 (0.5) 0 (0.0) 3 (1.4) 4 (1.9) occupational 1 (0.5) 2 (1.0) 0 (0.0) 1 (0.5) 0 (0.0) 4 (1.9) Zootoxic 5 (2.4) 4 (1.9) 0 (0.0) 3 (1.4) 6 (2.9) 18 (8.7) Intentional 23 (11.1) 36 (17.4) 29 (14.0) 26 (12.6) 16 (7.7) 130 (62.8) Addictive 2 (1.0) 3 (1.4) 1 (0.5) 3 (1.4) 2 (1.0) 11 (5.3) suicide 21 (10.1) 33 (15.9) 28 (13.5) 23 (11.1) 14 (6.8) 119 (57.5) murdered 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Toxic involved Medicinal 14 (6.8) 23 (11.1) 19 (9.2) 17 (8.2) 11 (5.3) 84 (40.6) antibiotics 2 (1.0) 0 (0.0) 0 (0.0) 1 (0.5) 1 (0.5) 4 (2.0) analgesics and anti-inflammatories 3 (1.4) 4 (1.9) 3 (1.4) 2 (1.0) 5 (2.4) 17 (8.2) Psychotropic 9 (4.3) 16 (7.7) 11 (5.3) 12 (5.8) 5 (2.4) 53 (25.6) Other drugs 0 (0.0) 3 (1.4) 5 (2.4) 2 (1.0) 0 (0.0) 10 (4.8) Not medicated 24 (11.6) 31 (15.0) 19 (9.1) 25 (12.1) 24 (11.6) 123 (59.4) Drugs of abuse 3 (1.4) 4 (1.9) 3 (1.4) 5 (2.4) 8 (3.9) 23 (11.1) Organic solvents 1 (0.5) 2 (1.0) 0 (0.0) 0 (0.0) 1 (0.5) 4 (2.0) Household products 2 (1.0) 10 (4.8) 1 (0.5) 3 (1.4) 5 (2.4) 21 (10.1) Inorganic substances 0 (0.0) 2 (1.0) 1 (0.5) 0 (0.0) 0 (0.0) 3 (1.4) Gases and fumes 1 (0.5) 0 (0.0) 1 (0.5) 3 (1.4) 1 (0.5) 6 (2.9) Pesticides 12 (5.8) 9 (4.3) 13 (6.3) 11 (5.3) 3 (1.4) 48 (23.2) Animal toxins 5 (2.4) 4 (1.9) 0 (0.0) 3 (1.4) 6 (2.9) 18 (8.7) Time of illness < 1 hour 5 (2.4) 12 (5.8) 6 (2.9) 9 (4.3) 9 (4.3) 41 (19.8) 1 to 2 hours 25 (12.1) 23 (11.1) 16 (7.7) 23 (11.1) 19 (9.2) 106 (51.2) 2 to 4 hours 0 (0.0) 3 (1.4) 7 (3.4) 4 (1.9) 3 (1.4) 17 (8.2) > 4 hours 8 (3.9) 16 (7.7) 9 (4.3) 6 (2.9) 4 (1.9) 43 (20.8) Routes of exposure Oral 30 (14.5) 46 (22.2) 36 (17.4) 33 (15.9) 25 (12.1) 170 (82.1) Cutaneous 5 (2.4) 4 (1.9) 0 (0.0) 4 (1.9) 7 (3.4) 20 (9.7) Respiratory 3 (1.4) 4 (1.9) 2 (1.0) 5 (2.4) 2 (1.0) 16 (7.7) Parenteral 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) 1 (0.5) Decontamination Unrealised 20 (9.7) 38 (18.4) 14 (6.8) 22 (10.6) 26 (12.6) 120 (58.0) Gastric lavage 18 (8.7) 16 (7.7) 24 (11.5) 19 (9.2) 8 (3.9) 85 (41.0) Skin wash 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) 1 (0.5) 2 (1.0) Use of antidote Administered 28 (13.5) 44 (21.3) 25 (12.1) 31 (15.0) 33 (15.9) 161 (77.8) Atropine 9 (4.3) 5 (2.4) 8 (3.9) 5 (2.4) 1 (0.5) 28 (13.5) Vitamin K 0 (0.0) 2 (1.0) 2 (1.0) 3 (1.4) 1 (0.5) 8 (3.9) Atropine + Vitamin K 1 (0.5) 1 (0.5) 2 (1.0) 0 (0.0) 0 (0.0) 4 (1.9) Flumazenil 0 (0.0) 1 (0.5) 0 (0.0) 2 (1.0) 0 (0.0) 3 (1.4) N-acetylcysteine 0 (0.0) 0 (0.0) 1 (0.5) 1 (0.5) 0 (0.0) 2 (1.0) Penicillamine 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) Request for interconsultation Not indicated 16 (7.7) 16 (7.7) 12 (5.8) 18 (8.7) 22 (10.6) 84 (40.6) Indicated 22 (10.6) 38 (18.4) 26 (12.6) 24 (11.6) 13 (6.3) 123 (59.4) Loyola-Gonzales E et al.: Antibiotic Use and Microbial Resistance Threat in a Peruvian Public Hospital8 prevalence in women. Occupational poisoning cases (4 in total) do not allow for statistical assessment of differences because neither the chi-square test nor the p-value (SD) are available, with adults being the most affected group. Zootoxic poisonings totalled 18 cases, distributed mainly amongst men (12 cases versus six in women) and with a Variables - Indicators 2022-I 2022-II 2023-I 2023-II 2024-I Total n (%) n (%) n (%) n (%) n (%) n (%) Consultation diagnosis Paranoid schizophrenia 2 (1.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (1.0) Depressive episode mod. 7 (3.4) 18 (8.7) 10 (4.8) 5 (2.4) 5 (2.4) 45 (21.7) Major depressive episode 3 (1.4) 2 (1.0) 2 (1.0) 1 (0.5) 3 (1.4) 11 (5.3) Recurrent depressive disorder 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) Disorders: Mixed anxiety and depression 2 (1.0) 4 (1.9) 5 (2.4) 5 (2.4) 1 (0.5) 17 (8.2) Post-traumatic stress disorder. 0 (0.0) 0 (0.0) 1 0.5) 0 (0.0) 0 (0.0) 1 (0.5) Other reactions to severe stress 0 (0.0) 0 (0.0) 1 (0.5) 2 (1.0) 1 (0.5) 4 (1.9) Emotional personality disorder. Unstable 1 (0.5) 1 (0.5) 0 (0.0) 6 (2.9) 1 (0.5) 9 (4.3) Habit-impulse disorder 1 (0.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) Oesophageal ulcer 0 (0.0) 1 (0.5) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) Acute renal failure 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) 1 (0.5) Hip dislocation 1 (0.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.5) No consultation was carried out 5 (2.4) 11 (5.3) 7 (3.4) 5 (2.4) 1 (0.5) 29 (14.0) Note. Own elaboration. Table 5. Distribution of acute chemical poisoning cases according to the clinical characteristics of patients treated in the emergency department of a public hospital in Ica, Peru (January 2022 to June 2024). ETIOLOGY SEX Total chi-square P-valuewomen man Age group n (%) n (%) n (%) Accidental incidental 21 10.1 30 14.5 51 24.6 5.030 0.284 child 12 5.8 17 8.2 29 14.0 teenager 2 1.0 0 0.0 2 1.0 Young person 3 1.4 6 2.9 9 4.3 adult 3 1.4 7 3.4 10 4.8 Senior citizen 1 0.5 0 0.0 1 0.5 Accidental iatrogenic 3 1.4 1 0.5 4 1.9 4.000 0.046 Young person 3 1.4 0 0.0 3 1.4 adult 0 0.0 1 0.5 1 0.5 Accident 0 0.0 4 1.9 4 1.9 NA NA Young person 0 0.0 1 0.5 1 0.5 adult 0 0.0 2 1.0 2 1.0 Senior citizen 0 0.0 1 0.5 1 0.5 Accidental zootoxic 6 2.9 12 5.8 18 8.7 2.250 0.69 child 0 0.0 1 0.5 1 0.5 teenager 0 0.0 1 0.5 1 0.5 Young person 2 1.0 6 2.9 8 3.9 adult 3 1.4 3 1.4 6 2.9 Senior citizen 1 0.5 1 0.5 2 1.0 Intentional addictive 5 2.4 6 2.9 11 5.3 1.925 0.382 teenager 1 0.5 0 0.0 1 0.5 Young person 3 1.4 3 1.4 6 2.9 adult 1 0.5 3 1.4 4 1.9 Intentional suicide 75 36.2 44 21.3 119 57.5 12.455 0.006 teenager 15 7.2 5 2.4 20 9.7 Young person 48 23.2 19 9.2 67 32.4 adult 11 5.3 19 9.2 30 14.5 Senior citizen 1 0.5 1 0.5 2 1.0 TOTAL 110 53.1 97 46.9 207 100.0 Note. Own elaboration. Pharmacia 72: 1–15 9 higher incidence in young people and adults, with no significant differences between sexes (χ² = 2.250; p = 0.69). In the case of addictive poisonings (11 cases), which affect men and women in equal proportions, a higher prevalence was observed amongst young people and adults (χ² = 1.925; p = 0.382). Finally, suicidal aetiology constitutes the largest group, with 119 cases, predominantly in women (75 cases) and in the age group of young people and adolescents, showing a significant difference between sexes (χ² = 12.455; p = 0.006). Overall, this table illustrates how the aetiology of poisoning relates to the sociodemographic characteristics of patients, with variations observed according to sex, age group, and nature of toxic exposure. Evolution of the clinical picture Table 6 presents a distribution of acute chemical poisoning cases according to their clinical evolution in a public hospital in Ica, Peru, during the period from January 2022 to June 2024. Regarding the length of hospital stay, it is observed that most patients, during the evaluated period, remained between 12 and 24 hours (33.3%) or more than 24 hours (30%), which could indicate that these cases require precise clinical management before stabilisation and discharge. A smaller proportion of patients were discharged in less than 6 hours (14%), possibly those with less severity and by decision of the patient or family members (voluntary discharge). Regarding discharge status, 61.8% of patients were discharged due to recovery status, while 35.7% opted for voluntary discharge, possibly for personal or family reasons, as a large number of these were associated with suicide attempts. This may indicate a lack of adequate follow-up for some cases that, although stable, could benefit from outpatient monitoring to prevent relapse. During the evaluated period, no cases of mortality were recorded, suggesting that no cases presented very severe or life-threatening symptoms. This is consistent with the severity scale reported in the medical records, as, according to the MINSA scale, “highly urgent” cases predominated in 48.3% of cases, while priority IV (common pathology) constituted 39.6% of cases. This supports the assertion that most of the cases of poisoning treated did not represent a critical threat, although they required appropriate medical intervention. This is reinforced by the IPCS–EAPCCT classification, where “minor” and “moderate” severity cases accounted for 51.7% and 48.3%, respectively, with no cases of severe or fatal poisoning recorded. The absence of cases in the most severe categories could be related to timely medical care, the magnitude of exposure to the toxic agent, or the low lethality of the toxic agents involved in the poisoning. Table 7 is a structured contingency table designed to assess whether there is a relationship between several important variables. Pearson’s chi-square test was used to evaluate whether there was a statistically significant relationship between the severity of the poisoning and the sociodemographic variables: sex, age group, clinical features, aetiology, and type of poisoning involved. Descriptive statistics and their relationship between variables The results show no significant relationship between sex and the severity of poisoning (p = 0.833), suggesting that both men and women presented poisoning Table 6. Distribution of acute chemical poisoning cases according to the evolution of the clinical picture in the emergency department of a public hospital in Ica, Peru (January 2022 to June 2024). Variables - Indicators 2022-I 2022-II 2023-I 2023-II 2024-I Total n (%) n (%) n (%) n (%) n (%) n (%) Hospital stay < 6 hours 3 (1.4) 8 (3.9) 4 (1.9) 4 (1.9) 10 (4.8) 29 (14.0) From 6 to 12 hours 7 (3.4) 14 (6.8) 4 (1.9) 15 (7.2) 7 (3.4) 47 (22.7) From 12 to 24 hours 14 (6.8) 17 (8.2) 18 (8.7) 13 (6.3) 7 (3.4) 69 (33.3) > 24 hours 14 (6.8) 15 (7.2) 12 (5.8) 10 (4.8) 11 (5.3) 62 (30.0) Download status Medical discharge 28 (13.5) 28 (13.5) 22 (10.6) 26 (12.6) 24 (11.6) 128 (61.8) Voluntary discharge 10 (4.8) 23 (11.1) 16 (7.7) 14 (6.8) 11 (5.3) 74 (35.7) the patient escaped 0 (0.0) 3 (1.4) 0 (0.0) 2 (1.0) 0 (0.0) 5 (2.4) Deceased 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) MINSA1 severity scale I: Extreme gravity 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) II: Major urgency 20 (9.7) 27 (13.0) 20 (9.7) 15 (7.2) 18 (8.7) 100 (48.3) III: Minor emergency 4 (1.9) 9 (4.3) 2 (1.0) 6 (2.9) 4 (1.9) 25 (12.1) IV: Common pathology 14 (6.8) 18 (8.7) 16 (7.7) 21 (10.1) 13 (6.3) 82 (39.6) IPCS Severity Scale-EAPCCT2 0: None 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1: Minor 18 (8.7) 27 (13.0) 18 (8.7) 27 (13.0) 17 (8.2) 107 (51.7) 2: Moderate 20 (9.7) 27 (13.0) 20 (9.7) 15 (7.2) 18 (8.7) 100 (48.3) 3: Severe 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4: Deadly 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Note. Own elaboration. 1MINSA: Ministry of Health, 2 IPCS-EAPCCT: International Programme on Chemical Safety - European Association of Poison Control and Clinical Toxicology Centres.