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O iginal Resea ch A icle
Clinical P o ile o Pa aqua Poisoning Pa ien in a Te ia y Ca e Hospi al
in No heas India: A P ospec i e Obse a ional S udy
Shubham Ashok Bodhe1, Gou ab Das2, Sh i ao Mayu Vilas ao3, Debad i a Das4,
Rajesh Kisho e Debba ma5
1Senio Residen Doc o , M.D. Gene al Medicine, Depa men o Gene al Medicine, Aga ala
Go e nmen Medical College & Go ind Ballabh Pan Hospi al, Aga ala, T ipu a 799006
2Senio Residen Doc o , M.D. Gene al Medicine, Depa men o Gene al Medicine, Aga ala
Go e nmen Medical College & Go ind Ballabh Pan Hospi al, Aga ala, T ipu a 799006
3Pos g adua e T ainee Doc o , M.D. Gene al Medicine, Depa men o Gene al Medicine, Aga ala
Go e nmen Medical College & Go ind Ballabh Pan Hospi al, Aga ala, T ipu a 799006
4Pos G adua e T ainee Doc o , M.D. Gene al Medicine, Depa men o Gene al Medicine, Aga ala
Go e nmen Medical College & Go ind Ballabh Pan Hospi al, Aga ala, T ipu a 799006
5P o esso , M.D. Gene al Medicine, Depa men o Gene al Medicine, Aga ala Go e nmen Medical
College & Go ind Ballabh Pan Hospi al, Aga ala, T ipu a 799006
Recei ed: 01-07-2025 / Re ised: 16-07-2025 / Accep ed: 13-08-2025
Co esponding Au ho : D . Gou ab Das
Con lic o in e es : Nil
Abs ac
In oduc ion: Pa aqua , a widely used he bicide in India, is associa ed wi h high mo ali y due o i s se e e
oxici y and lack o a speci ic an ido e. No heas India, being ag icul u ally in ensi e, equen ly encoun e s cases
o pa aqua poisoning, o en due o in en ional inges ion. Howe e , he e is limi ed egional da a desc ibing he
clinical p o ile and ou comes o such cases.
Objec i e: To s udy he clinical p esen a ion, demog aphic cha ac e is ics, labo a o y abno mali ies,
complica ions, and ou comes o pa ien s wi h pa aqua poisoning admi ed o a e ia y ca e hospi al in No heas
India.
Me hods: This p ospec i e obse a ional s udy was conduc ed o e 18 mon hs om Janua y, 2024 o June, 2025
a he Depa men o Medicine in a e ia y ca e hospi al in No heas India. All pa ien s wi h a con i med his o y
o pa aqua inges ion and posi i e u ine di hioni e es we e included. Demog aphic da a, amoun o pa aqua
consumed, ime o p esen a ion, clinical signs and symp oms, labo a o y pa ame e s (including enal, hepa ic, and
espi a o y unc ions), and ea men ou comes we e eco ded. Pa ien s we e ollowed up un il discha ge o dea h.
Desc ip i e s a is ics and ele an analy ical es s we e applied using SPSS.
Resul s: This p ospec i e s udy on pa aqua poisoning pa ien s a a e ia y ca e hospi al in No heas India
e ealed ha he majo i y we e young adul s aged 21–30 yea s (42.1%), p edominan ly om u al a eas (72.4%)
and engaged in a ming (39.4%). Mos had o mal educa ion (up o class X) and we e om non- ibal
communi ies, wi h a signi ican p opo ion epo ing suicidal in en (36.8%) and a his o y o psychia ic illness
(26.3%). The quan i y o poison consumed was mos ly be ween 21–30 ml (36.9%), wi h clinical mani es a ions
including omi ing (92.1%), o al ulce a ion (84.2%), swallowing di icul y (81.6%), and espi a o y symp oms.
Vi al signs o en showed achyca dia, achypnea, hypoxia, and blood p essu e abno mali ies. O gan dys unc ion
was equen , no ably acu e li e inju y (73.7%), acu e kidney inju y (71.1%), ARDS (47.4%), and lung ib osis
(36.8%). Hema ological indings e ealed no mal mean hemoglobin (12.8 ± 1.9 gm/dL) and ele a ed WBC in
43% o cases. Hospi al s ay was p olonged in many, wi h 27.6% equi ing mo e han 30 days o admission,
e lec ing he se e i y and sys emic impac o pa aqua poisoning.
Conclusion: Pa aqua poisoning emains a signi ican heal h conce n in No heas India wi h high mo ali y,
especially among young adul s. Ea ly diagnosis, agg essi e suppo i e ca e, and awa eness among he u al
popula ion ega ding i s le hali y a e c ucial o educe a al ou comes. Regional policies egula ing i s sale and
usage a e u gen ly wa an ed.
Keywo ds: Pa aqua poisoning, he bicide oxici y, No heas India, pulmona y ib osis, enal ailu e, p ospec i e
obse a ional s udy.
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In oduc ion
Pa aqua (me hyl iologen dichlo ide) is a po en
bipy idilium he bicide widely used ac oss
ag icul u al egions o India. Despi e bans in o e 70
coun ies, including Odisha since 2023 and Ke ala
in e mi en ly, i emains easily accessible and
inexpensi e, posing a se ious public heal h h ea
due o i s ex eme oxici y and absence o a speci ic
an ido e [1]. The minimum le hal dose is
app oxima ely 5 ml, making e en small exposu es
po en ially a al.
Clinically, pa aqua poisoning p esen s ini ially wi h
non‑speci ic symp oms such as omi ing, abdominal
pain, and o al ulce a ion. Howe e , p og essi e
o gan damage—pa icula ly acu e kidney inju y
(AKI), hepa ic dys unc ion, pulmona y in ol emen
including acu e espi a o y dis ess synd ome
(ARDS) and e en ual lung ib osis—is common,
o en culmina ing in mul io gan dys unc ion and
dea h wi hin days o weeks [2]. Se e al Indian
e ia y cen es ha e documen ed mo ali y a es
exceeding 70% in pa aqua inges ion cases [3].
Despi e his high bu den, epidemiological da a om
India emain limi ed o small se ies, case epo s,
and e ospec i e e iews, pa icula ly om
sou he n and cen al India. A s udy om Chennai
o e a h ee‑yea pe iod epo ed 10 ICU cases, all
suicidal in na u e, wi h 80% de eloping AKI and
100% mo ali y despi e suppo i e he apies such as
s e oids, cyclophosphamide, and dialysis. Simila ly,
a la ge e ospec i e analysis o 55 hospi alised
pa ien s om Sou h India eco ded a 72.7%
in‑hospi al mo ali y wi h AKI being he
p edominan o gan dys unc ion [4]. Ano he
mul icen e in es iga ion in Hyde abad e iewed 60
cases o se e e AKI equi ing neph ology ca e; 68%
died, and su i al was in luenced by he amoun
consumed and e e al la ency [5].
Mo e ecen ly, a p ospec i e coho om a e ia y
ca e cen e in no he n Ka na aka in ol ing 110
subjec s ound ha mo ali y emained high (≈72%)
despi e ea ly gas ic la age, in a enous luids,
me hylp ednisolone, and N‑ace ylcys eine
adminis a ion. Pulmona y ib osis, achyca dia,
achypnea, and o al ulce s we e commonly obse ed
[6]. A 2024 c i ical‑ca e se ies om Delhi egion
no ed ha ea ly haemope usion was associa ed wi h
imp o ed ou come (36% su i al among hose
ea ed), highligh ing he impo ance o ea ly
in e en ion; me abolic acidosis, enal impai men
and hepa ic dys unc ion co ela ed signi ican ly wi h
mo ali y [7].
Pa aqua ’s clinical signi icance is magni ied by
diagnos ic delays and mismanagemen . In many
cases, pa ien s p esen la e—o en mo e han
24 hou s pos inges ion—and ini ial managemen
may misclassi y pa aqua as o ganophospho us
poisoning, leading o inapp op ia e ea men such
as a opine, p alidoxime o oxygen he apy, which
can wo sen oxida i e inju y [8]. A case epo om
no he n India desc ibed a young male ini ially
ea ed o in luenza and diph he ia be o e he
diagnosis o pa aqua poisoning was made,
ul ima ely succumbing o pulmona y and enal
ailu e a e a p olonged clinical cou se [9].
Misdiagnosis no only delays a ge ed suppo i e
ca e bu also inc eases mo bidi y and mo ali y.
Gi en hese se e e clinical ou comes and diagnos ic
challenges, he e is a p essing need o p ospec i e,
egion‑speci ic s udies. Mos a ailable da a a e
e ospec i e and om sou he n India; li le is
known abou pa aqua poisoning p o iles and
ou comes in no heas e n s a es whe e ag icul u e is
p e alen and egula o y o e sigh may be weake .
Mo eo e , he impac o ea ly he apeu ic
in e en ions—such as haemope usion, dialysis,
immunosupp ession and an ioxidan he apy—on
su i al in eal‑wo ld se ings is inadequa ely
desc ibed.
The e is also limi ed da a on psychosocial and
beha io al de e minan s o pa aqua inges ion in his
con ex . S udies om S i Lanka and Sou h India
sugges ha impulsi e sel ‑ha m, alcohol abuse, and
amilial con lic a e p edominan causes, o en
among younge indi iduals (mean age <30 yea s),
wi h minimal p io psychia ic consul a ion [10].
Howe e , such beha iou al p o iles ha e no been
sys ema ically assessed in he no heas Indian
se ing.
The e o e, his p ospec i e obse a ional s udy was
conduc ed in a e ia y ca e hospi al in no heas e n
India wi h he ollowing objec i es: o desc ibe he
sociodemog aphic and beha iou al p o ile, clinical
p esen a ion, labo a o y pa ame e s, managemen
s a egies, and ou comes including mo ali y and
leng h o hospi al s ay among pa ien s wi h pa aqua
poisoning. We also aimed o e alua e ac o s
in luencing p ognosis, such as amoun inges ed,
ime o p esen a ion, p esence o me abolic acidosis
o o gan dys unc ion, and use o in e en ions like
haemope usion o enal eplacemen he apy.By
ocusing on no heas e n India—a egion
unde ep esen ed in p io li e a u e— his s udy
seeks o ill c i ical knowledge gaps and p o ide
egion‑ ailo ed e idence o guide clinical ca e,
public heal h policy, and p e en i e measu es
ega ding pa aqua poisoning.
Ma e ials and Me hods
S udy Design: C oss sec ional s udy.
S udy Type: Desc ip i e
Du a ion o he S udy
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This s udy will be comple ed wi hin 1 and ½ yea
[one yea o da a collec ion and 6 mon hs o da a
managemen ] om Janua y 2024 o June 2025 in
AGMC & GBPH Hospi al included in he s udy.
Sample Size: To al 76 pa ien s admi ed wi h
pa aqua poisoning in GB hospi al du ing s udy
pe iod we e en olled in he s udy.
S udy Va iables
• Age
• Religion
• Dwellings / Add ess
• Educa ional Le el
• E hnici y
• Occupa ion
• Ma i al s a us
Inclusion C i e ia: Pa ien s admi ed wi h his o y
o inges ion o pa aqua poisoning.
Exclusion C i e ia: Pa ien who consumed ano he
poison wi h pa aqua .
S a is ical Analysis: All da a eco ded in he
Pe o ma designed speci ically o his s udy
(Appendix). Desc ip i e s a is ics used o
summa ize he demog aphic cha ac e is ics, clinical
ea u es and ou come o he cases. The - es is used
o in es iga e he di e ences o con inuous a iables
be ween su i o s and non- su i o s. The
ela ionship be ween ca ego ical a iables and
ou come is e alua ed using chi squa e es . Da a
eco ded, en e ed and analyzed wi h compu e using
SPSS e sion 25.0. P alue o less han 0.05 is
conside ed as s a is ically signi ican .
Resul
Table 1: Sociodemog aphic Cha ac e is ics o he S udy Popula ion (N = 76)
Sociodemog aphic Cha ac e is ics
F equency (%)
P Value
Age g oup
≤ 20 yea s
19 (25.0)
<0.0001
21 – 30 yea s
32 (42.1)
31 – 40 yea s
21 (27.6)
40 yea s & abo e
4 (5.3)
Religion:
Hinduism
62 (81.6)
<0.0001
Islamic
14 (18.4)
Dwellings / Add ess:
Ru al
55 (72.4)
<0.0001
U ban
21 (27.6)
Educa ional Le el:
Up o Class V
24 (31.6)
0.0004
Up o class X
34 (44.7)
Up o class XII
14 (18.5)
E hnici y:
T ibal
20 (26.3)
<0.0001
Non- ibal
56 (73.7)
Occupa ion:
Fa me
30 (39.4)
<0.0001
Sel employed
20 (26.3)
Unemmployed
18 (23.6)
S uden
8(10.5)
Ma i al s a us:
Ma ied
42 (55.3)
<0.0001
Unma ied
28 (36.8)
Widow/e
6 (7.9)
Table 2: Clinical P o ile and Poison Cha ac e is ics o he S udy Popula ion (N = 76)
Clinical P o ile and Poison Cha ac e is ics
F equency (N%)
P Value
Amoun o poison consumed
Up o 10 ml
20 (26.3)
<0.0001
11-20 ml
22 (28.9)
21-30 ml
28 (36.9)
Abo e 30 ml
6 (7.9)
Vi al pa ame e s
Pulse a e – high
46 (60.5)
<0.0001
Al e ed blood p essu e
18 (23.7)
Respi a o y a e inc eased
48 (63.2)
Hypoxia
36 (47.4)
O gan dys unc ion o o gan inju ies
Acu e kidney inju y
54 (71.1)
<0.0001
Acu e li e inju y
56 (73.7)
Acu e Panc ea i is
24 (31.6)
Acu e espi a o y dis ess synd ome
36(47.4)
Lung ib osis
28 (36.8)
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Table 3: Clinical Fea u es and Como bidi ies Among Poisoning Cases (N = 76)
Clinical Fea u es and Como bidi ies
F equency (%)
Clinical ea u es
Vomi ing
70 (92.1)
Edema ous lips
26 (34.2)
O al mucosal ulce a ion
64 (84.2)
Swallowing di icul y
62 (81.6)
Speech di icul y
54 (71.1)
B ea hing di icul y
52 (68.4)
Pain abdomen
58 (76.3)
Oligu ia
40 (52.6)
Blood in omi us
36 (47.4)
Semiconsciousness
8 (10.5)
Como bidi ies
Hype ension
10 (13.2)
Hypo ension
8 (10.5)
Diabe es melli us
6 (7.9)
Suicidal a emp
28 (36.8)
Diagnosed psychia ic illness
20 (26.3)
Table 4: Labo a o y and Hema ological Pa ame e s o he S udy Popula ion
Labo a o y and Hema ological Pa ame e s
Mean, SD / F equency (%)
Labo a o y indings
Hemoglobin: (N=71)
12.8 ± 1.9 gm/dl
Hb ≥ 12.0 gm/dl
55 (77.5)
Hb 10.0-11.9 gm/dl
8 (11.2)
Hb 7.0-9.9 gm/dl
8 (11.2)
Hema ological pa ame e s
Pla ele coun (N = 72)
3.06 ± 0.8 lakh / mcL
Whi e blood cell coun (N=72)
10782 ± 4046 / mcL
High WBC (> 11000/mcL)
31 (43.0)
Table 5: Du a ion o Hospi al S ay Among Pa ien s (N = 76)
Du a ion o hospi al s ay in days
F equency (%)
Only 24 hou s o 1 day
4 (5.3)
2 - 5 days
12 (15.8)
6 – 10 days
8 (10.5)
11 – 20 days
19 (25.0)
21- 30 days
12 (15.8)
Mo e han 30 days
21 (27.6)
Figu e 1: Clinical P o ile and Poison Cha ac e is ics o he S udy Popula ion (N = 76)
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Figu e 2: Clinical Fea u es and Como bidi ies Among Poisoning Cases (N = 76)
The s udy popula ion p edominan ly comp ised
indi iduals aged be ween 21–30 yea s, accoun ing
o 42.1%, ollowed by 27.6% in he 31–40 age
g oup and 25.0% aged ≤20 yea s. Only 5.3% we e
aged abo e 40 yea s, wi h a s a is ically signi ican
dis ibu ion ac oss age g oups (p < 0.0001). The
majo i y o pa icipan s we e ollowe s o Hinduism
(81.6%), while 18.4% iden i ied as Islamic (p <
0.0001). Mos esponden s esided in u al a eas
(72.4%), wi h 27.6% li ing in u ban se ings (p <
0.0001). In e ms o educa ion, 44.7% had s udied
up o class X, 31.6% up o class V, and 18.5% up o
class XII, showing a signi ican associa ion wi h
educa ional le el (p = 0.0004). Rega ding e hnici y,
73.7% o pa icipan s we e non- ibal and 26.3%
we e ibal (p < 0.0001). The mos common
occupa ion was a ming (39.4%), ollowed by sel -
employmen (26.3%), unemploymen (23.6%), and
s uden s (10.5%) (p < 0.0001). In e ms o ma i al
s a us, 55.3% we e ma ied, 36.8% unma ied, and
7.9% we e widowed, also showing a s a is ically
signi ican di e ence (p < 0.0001).
The quan i y o poison consumed a ied, wi h he
majo i y (36.9%) inges ing 21–30 ml, ollowed by
28.9% who consumed 11–20 ml, and 26.3% who
consumed up o 10 ml. A smalle p opo ion (7.9%)
inges ed mo e han 30 ml o poison. This
dis ibu ion was s a is ically signi ican (p <
0.0001), sugges ing a dose- ela ed impac . Among
i al pa ame e s, a high pulse a e was obse ed in
60.5% o pa ien s, inc eased espi a o y a e in
63.2%, hypoxia in 47.4%, and al e ed blood p essu e
in 23.7% o cases—all s a is ically signi ican
indings (p < 0.0001), e lec ing he sys emic impac
o poisoning. O gan dys unc ion was p e alen in
his coho . Acu e li e inju y was he mos
common, seen in 73.7%, ollowed closely by acu e
kidney inju y (71.1%). Acu e espi a o y dis ess
synd ome (ARDS) occu ed in 47.4%, lung ib osis
in 36.8%, and acu e panc ea i is in 31.6% o
pa ien s, all showing s a is ically signi ican
occu ence a es (p < 0.0001).
The mos equen ly epo ed clinical ea u e was
omi ing, obse ed in 92.1% o cases. O he
common symp oms included o al mucosal
ulce a ion (84.2%), swallowing di icul y (81.6%),
pain abdomen (76.3%), and speech di icul y
(71.1%). B ea hing di icul y was no ed in 68.4% o
pa ien s, ollowed by edema ous lips (34.2%). Blood
in omi us was p esen in 47.4%, oligu ia in 52.6%,
and semiconsciousness in 10.5% o cases, e lec ing
he se e i y and sys emic na u e o he poisoning.
Rega ding como bid condi ions, 13.2% had
hype ension, 10.5% had hypo ension, and 7.9% had
diabe es melli us. No ably, 36.8% o he pa ien s had
a his o y o suicidal in en , and 26.3% had a
p e iously diagnosed psychia ic illness.
The mean hemoglobin le el among he 71
pa icipan s es ed was 12.8 ± 1.9 gm/dL. Mos
pa ien s (77.5%) had hemoglobin le els ≥12.0
gm/dL, while 11.2% each had alues in he ange o
10.0–11.9 gm/dL and 7.0–9.9 gm/dL, indica ing ha
a mino i y exhibi ed mild o mode a e anemia.
Rega ding hema ological pa ame e s, he mean
pla ele coun was 3.06 ± 0.8 lakh/mcL, and he
mean whi e blood cell (WBC) coun was 10,782 ±
4046/mcL. Ele a ed WBC coun (>11,000/mcL)
was obse ed in 43.0% o cases (n = 31).
The du a ion o hospi al s ay a ied widely among
he pa ien s. A small p opo ion (5.3%) we e
discha ged wi hin 24 hou s, while 15.8% s ayed o
2–5 days. Ano he 10.5% emained hospi alized o
6–10 days. A signi ican numbe o pa ien s equi ed
ex ended hospi aliza ion, wi h 25.0% s aying o 11–
20 days, 15.8% o 21–30 days, and no ably, 27.6%
o pa ien s equi ing hospi aliza ion o mo e han 30
days.
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Discussion
The demog aphic dis ibu ion obse ed in his s udy
aligns wi h simila indings ac oss India. The highes
incidence o poisoning occu ed among indi iduals
aged 21–30 yea s (42.1%), ollowed by he 31–40-
yea g oup (27.6%). This end was consis en wi h
Sha ma e al. and Ahe e al., who also ound he
majo i y o cases in young adul s, e lec ing
inc eased exposu e o s ess, occupa ional isks, and
psychosocial ulne abili y in his age g oup [11]. A
p edominance o u al esidency (72.4%) and
a ming as he leading occupa ion (39.4%)
co espond wi h ea lie epo s om No heas and
Cen al India, whe e u al ag icul u al wo ke s we e
mo e p one o pes icide exposu e due o easy access
and lack o egula o y en o cemen [12]. The
amoun o poison inges ed was mos ly in he 21–30
ml ange (36.9%), wi h a s a is ically signi ican
dose– esponse impac on clinical se e i y.
Compa able dose- ela ed oxici y and sys emic
e ec s ha e been documen ed in p e ious egional
s udies, pa icula ly wi h pa aqua and
o ganophospha e poisoning [13]. Vomi ing (92.1%)
was he mos commonly obse ed symp om,
ollowed by o al ulce a ion, swallowing and
b ea hing di icul ies, and abdominal pain— indings
ha mi o s udies conduc ed in simila hospi al-
based coho s dealing wi h co osi e o pes icide
inges ion [14]. The high equency o
gas oin es inal and espi a o y symp oms
unde sco es he co osi e and sys emic na u e o he
inges ed subs ances. O gan dys unc ion was
p ominen in he coho , wi h acu e li e inju y
(73.7%) and kidney inju y (71.1%) being he mos
common. Addi ionally, ARDS (47.4%), lung
ib osis (36.8%), and panc ea i is (31.6%) we e
equen ly epo ed. These a es a e highe han
hose in p e ious ICU-based s udies, whe e enal
and hepa ic complica ions we e p esen in ewe
pa ien s—possibly due o di e ences in poison ype
and access o ea ly in e en ions [15]. The
hema ological indings we e b oadly in line wi h
hose om p e ious s udies. The mean hemoglobin
was 12.8 ± 1.9 g/dL, wi h mos pa ien s ha ing
alues wi hin no mal ange. Ele a ed WBC coun s
(>11,000/mcL) we e ound in 43%, consis en wi h
in lamma o y esponses desc ibed in s udies o
o ganophospha e and o he sys emic poisons [16].
Psychosocial ac o s played a no able ole, wi h
36.8% o pa ien s ha ing a emp ed suicide and
26.3% ha ing diagnosed psychia ic illness. These
indings co obo a e he conclusions o
oxicological su eillance s udies emphasizing he
ising bu den o sel -ha m among young adul s in
India [17,18].
In e es ingly, 27.6% o pa ien s equi ed
hospi aliza ion beyond 30 days, a exceeding
du a ions epo ed in o he s udies, whe e median
hospi al s ays ypically anged be ween 2–7 days
[19,20]. This ex ended hospi al cou se likely e lec s
he se e i y o poisoning, complica ions like o gan
ailu e, and delayed p esen a ions, all o which
con ibu e o p olonged eco e y imes.
Conclusion
Pa aqua poisoning emains a signi ican public
heal h challenge in India, pa icula ly in ag a ian and
unde se ed egions such as No heas India. This
s udy highligh s he p edominan ly young, u al
popula ion a ec ed, wi h inges ion o en linked o
suicidal in en . The clinical cou se is ma ked by
ea ly gas oin es inal symp oms ollowed by apid
p og ession o mul io gan dys unc ion—mos
no ably acu e kidney inju y, hepa ic impai men , and
pulmona y ib osis. Labo a o y abno mali ies such
as leukocy osis and ele a ed in lamma o y ma ke s
we e common, while ele a ed whi e blood cell coun
co ela ed wi h poo p ognosis. Despi e suppo i e
he apies, mo ali y a es emain high, especially
among pa ien s who consume la ge quan i ies o
poison o p esen la e o he hospi al. The indings
unde sco e he u gen need o imp o ed awa eness,
ea ly diagnosis, and egion-speci ic ea men
p o ocols, including imely access o in e en ions
like haemope usion and enal eplacemen he apy.
Fu he mo e, egula o y con ol o e pa aqua sales
and s onge men al heal h suppo sys ems a e
c ucial o p e en ing in en ional sel -ha m using
such le hal subs ances. This p ospec i e
obse a ional s udy con ibu es aluable egional
da a and emphasizes he impo ance o in eg a ing
oxicological su eillance, public heal h policy, and
psychia ic ca e o add ess he complex clinical and
social dimensions o pa aqua poisoning.
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