3.1 Types of Poison

Pesticides, including insecticides, rodenticides, and insect repellents, were responsible for 76.4% (n = 307) of poisoning cases. Among the pesticides, organophosphates were the most common, accounting for 57.7% (n = 232) of the total cases, followed by rodenticide poisoning (14.4%, n = 58). Accidental mushroom poisoning accounted for 8% (n = 32) of the total cases. Five percent (n = 20) of the total patients were poisoned by therapeutic drugs. Other poison types included multiple medications, insect repellents, deliriants, and unspecified substances, with a smaller distribution across cases (Table 2).

3.2 History and Clinical Examination

The route of exposure was ingestion in 99.5% (n = 400) of cases, with the remaining cases comprising one case exposed through ingestion, injection, and inhalation (0.2%, n = 1) and one case exposed through inunction (0.2%, n = 1). The reason for poisoning was intentional (self-harm) in 70.9% (n = 285) of cases, accidental in 28.9% (n = 116), and unknown in one case. In terms of consciousness upon admission, 90.8% (n = 365) of the patients were conscious, 8.5% (n = 34) were unconscious, and 0.2% (n = 1) were drowsy. The vital parameters of the patient at presentation to the ED are shown as depicted in Table 3, reported as means with SD. Significant differences between accidental and self-harm poisoning cases were observed in heart rate (p = 0.03), respiratory rate (p = 0.04), and temperature (p = 0.01), with accidental cases showing higher mean values for heart rate (96.47 vs. 90.81 bpm) and respiratory rate (22.92 vs. 21.42/min), and a slightly higher temperature (97.85°F vs. 97.71°F). No significant differences were found in systolic (p = 0.89) or diastolic blood pressure (p = 0.74).

3.3 Provided Consultations

Only 1% (n = 4) of the patients received medicolegal consultation, whereas 68.7% (n = 276) received psychiatric consultation. For 99% (n = 398) of the cases, medicolegal consultations were not mentioned, and psychiatric consultation was not noted for 31.3% (n = 126).

3.4 Reasons for Poisoning

There were 116 cases of accidental poisoning and 285 cases of self-harm. Alcohol intoxication accounted for 7.5% (n = 30) of total cases, with 5.0% (n = 20) linked to intentional self-harm among adults and 2.5% (n = 10) unintentional, including one case of a 5-year-old boy who accidentally ingested ethanol. The major underlying cause of deliberate self-harm caused by poisoning was found to be familial conflict, mental health issues, financial hardship, relationship problems, and academic stress, as depicted in Table 4.

3.5 Outcome

The hospital stay ranged from 1 to 15 days, with a mean duration of 4.44 ± 2.287 days. A majority of patients (90.8%, n = 365) did not follow up postdischarge, whereas 9.2% (n = 37) attended follow-up sessions. In terms of medical outcomes, 400 patients were discharged, one patient (a 19-year-old unmarried female, intentional organophosphorus insecticide poisoning via ingestion, with a history of mental health issues) was referred to a specialized facility after 10 days of hospitalization for advanced critical care due to persistent complications, and one patient (a 59-year-old married male, intentional organophosphorus insecticide poisoning via ingestion under the influence of alcohol for self-harm) died after 5 days of admission.

4.1 Demographic Characteristics

This study revealed a distinctive demographic profile of poisoning cases. The median age was 26.5 years, with a female predominance (61.2%), younger than the mean ages reported at Scheer Memorial Adventist Hospital (37.12 ± 14.07 years for organophosphate cases, 27.41 ± 9.79 years for non-organophosphate cases) [9]. Studies on poisoning from other Asian countries depict a similar picture in which female patients are more at risk and adolescents and young adults constitute a vulnerable age group [4, 10].

Although married individuals accounted for the majority of poisoning cases (65.7%), this percentage was marginally lower than that reported in a record-based study from southern India, which reported that 74.8% of the cases were among married people [11]. This finding on age and gender suggests that social and familial factors may contribute to poisoning, warranting future investigation into these potential risk factors.

4.2 Poisoning Patterns

Although organophosphate dominates poisoning cases at LMC (57.7%, n = 232), reflecting their accessibility in Nepal's agrarian context, the GBD Study 2019 indicates a broader range of causative agents for unintentional poisoning in South Asia, including carbon monoxide and other chemicals [8]. The GBD data show a 63.8% reduction in age-standardized death rates from “other means” (e.g., pesticides, drugs) between 1990 and 2019, contrasting with a smaller 33.1% decline for carbon monoxide-related deaths [8]. This suggests that although unintentional pesticide poisoning may be decreasing regionally, intentional pesticide use, prevalent in our study, remains a critical public health challenge in Nepal, potentially driven by psychosocial factors rather than accidental exposure.

Ingestion emerged as the most predominant route of poisoning, accounting for 99.5% of the cases. This method of exposure aligns with the findings of a study of poisoning cases visiting the ED of Kathmandu Medical College Teaching Hospital, where ingestion accounted for 86.57% of the cases [12].

4.3 Temporal and Contextual Factors

Family conflicts emerged as the primary reason for intentional poisoning, followed by mental health issues. This pattern mirrors findings from Nepal Medical College and Teaching Hospital, Kathmandu [2].

On the other hand, patients considered suicide attempts to manipulate the environment or to seek attention as per a study conducted among patients visiting psychiatric OPDs at Shree Birendra Hospital, Kathmandu, Nepal [13].

Academic stress contributes to self-harm in students. However, the pattern of poisoning is different in medical and nursing students, who have abused prescription drugs and medications more than pesticides. One of the reasons might be that they know the properties and treatment of the drugs and that these medications are more easily accessible to them than are pesticides [14, 15].

The high prevalence of intentional poisoning among young adults may be due to low job opportunities and economic achievement, which lead to the loss of hope [10, 16].

In the present study, a characteristic time pattern of poisoning incidents was also observed, with a large proportion of exposure in the evening hours. This evening peak, particularly among females and married individuals aged 25–44 years is in line with a Nepali study conducted in Chitwan which also observed high number of cases (43.7%) in the evening hours (median hour: 17:22, mode: 22:00 h) [26]. GBD Study's long-term trend analysis shows a consistent decline in unintentional poisoning mortality across South Asia from 1990 to 2019 (−55.88% in age-standardized death rate) [8]. Nepal, however, bucks this trend with a slight increase in unintentional poisoning incidence (IRR 0.97, 95% CI 0.94–1.00) [8], suggesting that local factors—such as evening stress accumulation or pesticide availability—may sustain poisoning rates despite regional improvements. This temporal clustering warrants further investigation into diurnal risk factors specific to Nepal. Similar to studies on human mortality that show circadian rhythms in death rates [17], the results of the present study indicate that poisoning incidents may also exhibit nonrandom temporal distributions. The timing of poisoning may be affected by several factors, such as the psychological stress that accumulates throughout the day, decreased social support or supervision during evening hours, the culmination of interpersonal conflicts or emotional stress, and potential associations with work or family stress patterns [17]. Further prospective studies are needed to examine temporal clustering in poisoning.

4.4 Clinical Management and Outcomes

The treatment of the poisoning cases was determined according to the substance category, time of recognition of poisoning, age of the patient, and poison-related factors. On a case-by-case basis, both pharmacological and nonpharmacological care were provided. Gastric lavage was performed in 19.9% of the patients, similar to the 17% reported in an Ethiopian study [3], and charcoal was used in only 16.2% of the total patients. The most frequent pharmacological treatment was atropine, the antidote for organophosphate poisoning. This finding was consistent with other Nepalese studies [6, 18].

Organophosphorus compound poisoning causes profound bradycardia and hypotension. The peradeniya organophosphorus poisoning (POP) scale, which is used to assess clinical severity and determine prognosis in poisoned patients, utilizes six clinical parameters, including the respiratory rate and heart rate [19].

Supportive care, including fluid administration and decontamination, is crucial in managing poisoning complications. These results suggest that most treatments are supportive or symptomatic. This may be because of the limited ability of standardized diagnostic laboratory tests to ascertain the precise chemical agent so that the clinician can administer a specific antidote [20]. Similarly, a study in India reported that 80.2% of the cases had undergone gastric lavage and that 40% of the poisoning cases were treated with IV fluids [21].

The study demonstrated an exceptionally low mortality rate of 0.2%, which was significantly lower than that reported in an Iranian study (2.3%) [22] and a Nepalese study (5%) [23].

In an autopsy-based study from Palpa, Nepal, there were only 9 cases of poisoning of 184 cases, accounting for 4.9% of the total autopsies conducted in the mortuary of the District Hospital, of which 3 were male and 6 were female [24]. A hospital-based study of poisoning from eastern Nepal reported 17.6% mortality out of 85 cases of poisoning in 2 years [25]. A descriptive epidemiological study from 2015 on insecticide poisoning in central Nepal reported 439 cases of acute pesticide poisoning during a 9-month study, 3.8% of which died [26]. Similarly, a study in Ethiopia reported 1.5% mortality among poisoning cases [27]. The lower mortality in the case of pesticide poisoning may be due to early transport to the hospital, decontamination by gastric lavage and charcoal, the availability of specific antidotes, and the management of complications with intensive care support [28].

4.5 Health Impact Beyond Mortality

Although our study reports a low mortality rate (0.2%), the broader health impact of poisoning, including disability, remains unquantified. The GBD Study 2019 estimates that unintentional poisoning in South Asia resulted in 34,053.8 disability-adjusted life-years (DALYs) per 100,000 in 2019, with a 5.9% increase in years lived with disability (YLDs) [8]. At LMC, the predominance of organophosphates (57.7%, n = 232), aligning with national trends where OPs account for 39.6%–65% of poisonings [29], and the high intentionality (70.9%) suggest a significant hidden burden. Nationally, pesticide suicides rose 13-fold from 1980 to 2019, with methyl parathion and dichlorvos historically prominent despite bans (e.g., 2006, 2019), indicating persistent exposure risks [29]. In Lumbini Province, studies report similar OP dominance (e.g., 50/138 cases, 2014–2017) with low mortality (0.7%), mirroring our findings and hinting at a survivor cohort at risk of chronic morbidity [29].

Given the 68.7% psychiatric consultation rate and low follow-up (9.2%) at LMC, survivors—particularly young women (61.2%)—may face prolonged psychological and neurological impairments, such as depression or OP-induced neuropathy, not captured by mortality statistics. Utyasheva et al. [29] note that 87%–97% of poisonings are intentional, yet mortality ranges from 3% to 18.7%, suggesting many survive with sequelae [29]. Estimating DALYs and YLDs could reveal this burden, especially as regulatory efforts (e.g., 2019 bans on dichlorvos, aluminum phosphide) may reduce deaths but not morbidity if smuggling or misidentification persists. Enhanced forensic toxicology and hospital surveillance, as recommended by Utyasheva et al. [29], are critical to quantify these impacts and inform post-discharge care strategies.

4.6 Consultations and Follow-Up

The majority of the patients in the present study received psychiatric consultation, and a few received additional medicolegal consultation. The primary reason for poisoning in the present study was suicidality as a result of stress. Among the numerous factors contributing to stress, the most common are family conflict, broken relationships, financial hardship, and academic pressure [28, 30, 31]. Female youth are vulnerable, as they are not able to cope with stressful life situations [28, 32]. Mental illness is considered a social taboo in the country; therefore, reluctance is observed among patients seeking medical care [33]. Unlike people with physical illnesses, which attract immediate medical attention, mentally ill people rarely seek medical care [33]. The majority of patients, once cured of poisoning and free of signs and symptoms, seek discharge without completing psychiatric counseling sessions. They rarely follow up at the psychiatry department for the completion of counseling. Without treating the root cause of suicide, mere treatment of the poisoning leaves them vulnerable to future suicides. A history of suicide, depression, and other mental illness is a major risk factor for future suicide, especially within 5 years of a previous suicide attempt [34].

4.7 Public Health Implications

These implications underscore the complex nature of poisoning as a public health issue, emphasizing the need for a multifaceted approach involving healthcare, social services, and community-based interventions.

4.8 Limitations and Future Research Directions

There are limitations identified in the present study. First, this was a single-center, retrospective designed study, which limits the generalizability of the findings. This study relied on hospital records; however, there might have been underreporting of poisoning cases.

Future research can include multicenter, prospective studies, studies on comprehensive mental health intervention programs and community-based poison prevention strategies, and detailed psychiatric follow-up studies.