Clinico-epidemiology of washing powder (‘Prinso’) poisoning in Sri Lanka

Background: ‘Prinso’ is a fabric stain remover, which is consisted of two sachets, one containing brown crystals (potassium permanganate) and the other white granules (calcium oxalate). The product is made by small scale manufacturers of Sri Lanka and has become popular as a remover of stains. Recently, deliberate self-poisoning with ‘Prinso’ has become common in both rural and urban areas of Southern Province of Sri Lanka.Methods: A prospective clinical study was conducted in Teaching Hospital Ratnapura, Sri Lanka over ۳ years commencing from July ۲۰۱۷. Epidemiological data, clinical features, treatments, and outcomes were collected. The data were analyzed through SPSS software version ۲۱, using descriptive statistics.Results: There were ۲۷۴ (۹.۵%) patients with ‘Prinso’ poisoning out of which ۱۴۰ (۵۱%) were males and ۱۳۴ (۴۹%) were females. All were deliberate self-poisonings and ۱۱۷ (۴۳%) ingested oxalate alone; ۳۱ (۱۱%) ingested only permanganate, and ۱۲۶ (۴۶%) ingested both chemicals. The age ranged from ۱۳-۸۰ years (mean ۳۱.۶ ± ۱۴ years) and the most commonly affected age group was ۱۲-۳۱ years (۱۶۵;۶۰%). The majority of patients were unemployed (۱۰۸;۳۹%) and ۲۲ (۸%) schooling children. Most patients (n=۱۴۵;۵۳%) were admitted to hospital within ۱-۴ hour of the ingestion (median ۲ hrs and IQR ۲-۴ hrs) from Ratnapura (n=۷۴;۲۷%). Most of them (n=۷۸;۲۸.۵%) were treated at hospital for ۳ days (mean ۴.۸ days, IQR ۲-۶ days). Decontamination was done for ۸۸% (n=۲۳۹). Gastrointestinal symptoms including nausea (n=۹۰;۳۳%), vomiting (n=۱۹۳;۷۰%) and epigastric pain (n=۱۴۱;۵۲%) occurred frequently. The main complications among the patients were acute kidney injury [AKI] (۱۱۰;۴۰%), hypocalcemia (۳۸;۱۴%), hypotension (۲۹;۱۱%), ECG changes (۲۷;۱۰%), and methemoglobinemia (۲۶;۹.۵%). Hemodialysis was done for ۳۹ (۱۴%) and ۲۰ (۷%) were treated at intensive care unit from which ۱۳ (۵%) were intubated. Methylene blue (antidote) was given to ۲۵ (۹%). Leukocytosis was observed in ۱۱۸ (۴۳%) patients and ۲۳۶ (۸۶%) were recovered. Despite medical attempts, ۲۲ (۸%) died. Case fatality rate for ‘Prinso’ poisoning was found to be ۶.۶% (۹۰% CI ۲.۳-۱۳.۴;P < ۰.۰۵).Conclusions: ‘Prinso’ is a deadly poisoning household agent and AKI is the most common clinical manifestation.  

Keywords:

Oxalate , Acute kidney injury , Methemoglobinemia , Methylene blue , Washing Powder