Re: A One-Year Profile Of Acute Poisoning Cases In a Tertiary Care Emergency Department, Eurasian J Toxicology. 2025;6(3):45-49.

Abstract

Dear Editor, We commend Özdal and Yüksel¹ for their comprehensive retrospective evaluation of acute poisoning cases presenting over one year to a tertiary emergency department in Türkiye. Their structured comparison of intentional and unintentional exposures, encompassing demographic characteristics, toxic agents, temporal patterns, and hospitalization outcomes, provides clinically meaningful insights for the emergency toxicology community and strengthens intent-based risk stratification in acute care settings. While suicide represents a broader public health challenge beyond the scope of this correspondence, the use of pharmaceutical and other toxicological substances for self-harm remains directly relevant to the present discussion. In emergency departments worldwide, intentional self-poisoning constitutes the majority of adult toxicologic presentations, particularly among younger individuals. Large surveillance systems from North America and Europe consistently identify pharmaceuticals, especially analgesics, antidepressants, and sedative-hypnotics, as well as alcohol, as the most commonly implicated agents in intentional exposures²˒³. The distribution observed in this cohort, with medications and alcohol predominating among intentional cases, aligns with these established international epidemiologic patterns. However, poisoning epidemiology differs substantially in low- and middle-income countries (LMICs), where highly hazardous pesticides remain a major cause of both fatal and nonfatal intentional poisoning. In rural regions of South and Southeast Asia, sub-Saharan Africa, and parts of Latin America, agricultural chemicals, including but not limited to organophosphates, paraquat, and aluminium phosphide, are implicated in self-harm and are associated with higher case fatality rates than pharmaceutical overdoses commonly seen in high-income countries4. In such settings, emergency departments face considerable strain managing multiple cases of severe poisoning, often without specific antidotes, resulting in high morbidity and poor outcomes. The relatively low proportion of pesticide-related exposures in the present study (1.1%) likely reflects contextual and regulatory factors rather than the urban tertiary setting alone. Türkiye’s regulatory toxicology framework continues to align with European Union standards, including tighter controls on pesticide availability and distribution, as well as stricter maximum residue limits for export; collectively, these measures may restrict access to highly hazardous compounds⁵. Furthermore, patterns of pesticide self-poisoning vary considerably across sociocultural contexts, as the choice of agent in intentional exposures is strongly influenced by local availability, agricultural practices, and cultural norms. Accordingly, the lower frequency of pesticide-related cases in this cohort appears consistent with regulatory safeguards and context-specific behavioural patterns, rather than simple underrepresentation. While the sociobehavioral determinants underlying the selection of pesticides as a method of self-harm remain complex and continue to be examined by anthropologists, psychologists, and sociologists, evidence shows that restricting access to highly hazardous pesticides through regulatory bans not only reduces pesticide-related suicides but also contributes to a decline in overall suicide rates4. Nevertheless, the present study adds to the existing body of evidence by highlighting not only the greater clinical severity associated with intentional poisonings but also the strong association between alcohol abuse and intentional exposure. Like pesticide suicide in LMICs, carbon monoxide poisoning is context-specific and more prevalent in regions requiring indoor heating; seasonally targeted public health interventions are essential to reduce preventable exposure, morbidity, and mortality. Conflict of interest: None to declare. Financial support: Nil. A Ethics committee approval: Not applicable.

Keywords

• acute poisoning
• intentional self-poisoning
• emergency department
• pharmaceutical overdose
• pesticide poisoning
• suicide prevention
• alcohol-related toxicity
• regulatory policy

References

1. Özdal MT, Yüksel M. A One-Year Profile of Acute Poisoning Cases in a Tertiary Care Emergency Department. Eurasian J Tox [Internet]. 2026 Jan. 1;7(3):45-9. Available from: https://izlik.org/JA47JZ98WC
2. Beuhler MC, Feldman R, Gummin DD, Mowry JB, Rivers LJ, Brown K, et al. 2024 Annual report of the National Poison Data System® (NPDS) from America’s Poison Centers ® : 42nd annual report. Clin Toxicol (Phila) [Internet]. 2025; 63(12):1029–280. Available from: http://dx.doi.org/10.1080/15563650.2025.2571299
3. Lewer D, Brothers TD, Gasparrini A, Strang J. Seasonal, weekly and other cyclical patterns in deaths due to drug poisoning in England and Wales. Addiction [Internet]. 2023; 118(8):1596–601. Available from: http://dx.doi.org/10.1111/add.16175.
4. Rubbo B, Tu C-Y, Barrass L, Chang S-S, Konradsen F, Gunnell D, et al. Preventing suicide by restricting access to Highly Hazardous Pesticides (HHPs): A systematic review of international evidence since 2017. PLOS Glob Public Health [Internet]. 2025; 5(2):e0003785. Available from: http://dx.doi.org/10.1371/journal.pgph.0003785.
5. Ministry revises tolerable pesticide residue limits in food items. Hürriyet Daily News [Internet]. [cited 2026 Feb 19]. Available from: https://www.hurriyetdailynews.com/ministry-revises-tolerable-pesticide-residue-limits-in-food-items-204483.