Toxicological epidemiology and utilization patterns of Nepal's first institution-based poison information center.

Authors

Ramu Kharel, Rakesh Ghimire, Pravin Prasad, Akritee Pokharel, Rajesh Sharma, Anish Mudwari, Pradip Gyanwali, Sangha Ratna Bajracharya, Anup Pandey, Rishika Karki, Ayushma Pandit, Apekshya Bista, Vitasta Muskan, Prabhat Adhikari, Kabin Malekhu, Yagya Timalsina, Anjana Thapa, Enver Hayes, Janette Baird, Ziad Kazzi

Published in

Clinical toxicology (Philadelphia, Pa.). Pages 1-9. Nov 12, 2026. Epub Nov 12, 2026.

Abstract

Poisoning remains a major cause of preventable morbidity and mortality in low- and middle-income countries, yet Nepal has historically lacked centralized toxicology surveillance and consultation services. In 2023, piloting of an institution-based poison information center was done at Tribhuvan University Teaching Hospital through a multi-national collaboration. We describe the epidemiology, utilization patterns, and clinical characteristics of cases managed during the pilot phase of the Nepal Poison Information Center.
We conducted a descriptive analysis of prospectively collected data from all consultations reported to the Nepal Poison Information Center between September 2023 and December 2024. Trained poison center specialists documented demographic characteristics, exposure details, toxicological agents, consultation characteristics, and clinical disposition using a secure database. Data cleaning and descriptive analyses were conducted using SAS statistical software (version 9.4; SAS Institute Inc., Cary, NC).
A total of 393 poisoning cases were managed during the pilot period (September 2023-December 2024). Most patients were aged 18-39 years (53.4%), and 53.7% were female. Suspected intentional self-harm (suicidal-intent) accounted for 55.0% of exposures. Pesticides were the most common toxicological agents (46.1%), with insecticides (50.3%) and rodenticides (26.0%) predominating. Non-pesticide exposures included mushroom poisoning (8.1%), chemical exposures (7.6%), snake envenomation (6.9%), and medication-related poisonings (3.3%). The median time from exposure to poison information center phone call was four hours (IQR 1.0-15.0 hours). International toxicology experts were consulted in 28.2% of cases. The most common initial clinical disposition was observation in the emergency department (39.2%).Discussion:First, cases were dominated by intentional exposures, with suspected suicide accounting for 55% of all consultations. Second, pesticides represented nearly half of all primary toxicological agents (46.1%), with insecticides and rodenticides as the most common subtypes. Third, nearly one in three cases required consultation with international toxicology experts (28.2%), highlighting both the complexity of poisoning presentations and the limited availability of specialized toxicology expertise within Nepal. Together, these findings demonstrate that the pilot institutional PIC successfully operationalized a 24/7 toxicology consultation and follow-up model (previously described) while generating a centralized dataset capable of informing toxicovigilance, suicide prevention strategies, and regulatory policy. The PIC's model requires a daily follow up (and earlier if clinically indicated) of the patient (via phone by calling the treating providers) to acquire patient's clinical status and disposition plan. This study highlights the essential components required for sustainable poison center operations, including dedicated staffing, reliable telecommunications infrastructure, structured training pathways, continuous quality improvement processes, and integration of poisoning management within national emergency care and public health frameworks. Anchoring the pilot at Tribhuvan University Teaching Hospital, a government-affiliated academic institution, was a strategic decision that provided institutional credibility, access to clinical pharmacology leadership, and a platform for national advocacy.
During its pilot phase, Nepal's first institutional poison information center successfully delivered nationwide toxicology consultation and generated a centralized poisoning dataset. The predominance of intentional pesticide exposures and rising burden of other agents underscores the need for integrated suicide prevention strategies, strengthened pesticide regulation, and sustained investment in toxicology capacity and poison center infrastructure in Nepal.

PMID:
43017926
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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