Epidemiology of Toxicologic Exposures Reported to Nepal’s First Poison Information Center During a 15-Month Period

Low-and middle-income countries face a high burden of poisoning-related morbidity and mortality, yet access to timely toxicology expertise remains limited. Nepal has historically lacked a formal poison information system, contributing to delays in evidence-based management and limited national surveillance data. In September 2023, Nepal’s first hospital based poison information center (PIC) was launched at a public-governmental institution. This study describes patient characteristics, exposure patterns, and clinical outcomes during the PIC pilot phase from September 2023-December 2024.

We conducted a cross-sectional analysis of all toxicological exposures reported to the PIC in the pilot phase. Trained poison center specialists received calls from healthcare professionals across Nepal and provided information on management, and documented intake and follow up data in a REDCap database. Demographic characteristics, exposure circumstances, toxicological agents, time to presentation, use of international toxicology consultation, disposition and clinical outcomes were analyzed descriptively.

A total of 393 patients were included. Most were aged 18–39 years (53.4%), and 53.7% were female. Intentional suspected suicide cases represented 55.0% of all exposures. Pesticides (46.1%) (which includes insecticides, rodenticides and herbicides) were the most common toxicological agent; of which, 50.3% were insecticides and 26.0% rodenticides. Other exposure agents included mushrooms (8.1%), chemicals (7.6%), snake bites (6.9%), analgesics/antipyretics (5.6%), household products (4.6%), and pharmaceuticals (3.3%). The median time from exposure to presentation was 4 hours (IQR 1, 15). Ingestion was the most common exposure route (82.8%). An international toxicology expert was consulted in 28.2% of cases. The most frequent initial disposition was observation (39.2%), followed by admission to critical care (10.7%) and inter-facility transfer (7.9%). Total overall mortality <1% (3 patients).

During this pilot phase, Nepal’s first institutional PIC managed a substantial burden of poisoning cases, dominated by intentional pesticide exposures among young adults. Early findings highlight the critical role of poison centers in supporting emergency care and national toxico-survillence efforts that could guide preventative strategies.