Emerging epidemic of fatal human self-poisoning with a washing powder in Southern Sri Lanka: a prospective observational study

Abstract

Introduction. Self-poisoning is a public health problem in Sri Lanka. A new laundry detergent consisting of a sachet each of 1.2 g of potassium permanganate and 12.5 g of oxalic acid has become a popular agent among the youth for self-poisoning. Method. Prospective clinical data and major outcomes were recorded in all patients admitted to a referring and a referral hospital. Serial biochemistry was performed in 20 patients. Postmortem examinations were performed in some patients. Results. There were 115 patients. The majority developed symptoms of the gastrointestinal tract within the first 24 h. There were 18 deaths. Ingestion of oxalic acid was associated with a case fatality ratio of 25.4% (95% CI = 14–39), while ingestion of both potassium permanganate and oxalic acid was associated with a case fatality ratio of 9.8% (95% CI = 3.2–21). Ingestion of more than one sachet was associated with a significantly higher risk of death (risk ratio = 13.26, 95% CI = 3.2–54, p < 0.05). Majority of the deaths occurred within an hour since ingestion. Postmortem examinations revealed mucosal ulceration in the majority of deaths. Discussion. This case series brings to light an emerging epidemic of fatal self-poisoning in Sri Lanka from a compound that is not regulated. As deaths occur soon after ingestion, medical management of these patients is bound to be difficult. Conclusion. This case series highlights a fatal mode of self-poisoning that could be controlled through regulation of the manufacture and sale of the product.

Keywords:

• Acute poisoning
• Cardiorespiratory collapse
• Death

Acknowledgments

We thank the research assistants attached to the South Asian Clinical Toxicology Research Collaboration (SACTRC). SACTRC is funded by Wellcome Trust & Australian National Health and Medical Research Council International Collaborative Capacity Building Research Grant (GR071669MA). IG is funded by AusAID grant no. ALA 000379.