title: Emerging epidemic of fatal human self-poisoning with a washing powder in Southern Sri Lanka: a prospective observational study.
abstract: BACKGROUND
  Self-poisoning is a public health problem in Sri Lanka. A new laundry detergent consisting of a sachet each of 1.2 g of potassium permanganate and 12.5 g of oxalic acid has become a popular agent among the youth for self-poisoning.
  
  
  METHODS
  Prospective clinical data and major outcomes were recorded in all patients admitted to a referring and a referral hospital. Serial biochemistry was performed in 20 patients. Postmortem examinations were performed in some patients.
  
  
  RESULTS
  There were 115 patients. The majority developed symptoms of the gastrointestinal tract within the first 24 h. There were 18 deaths. Ingestion of oxalic acid was associated with a case fatality ratio of 25.4% (95% CI = 14-39), while ingestion of both potassium permanganate and oxalic acid was associated with a case fatality ratio of 9.8% (95% CI = 3.2-21). Ingestion of more than one sachet was associated with a significantly higher risk of death (risk ratio = 13.26, 95% CI = 3.2-54, p < 0.05). Majority of the deaths occurred within an hour since ingestion. Postmortem examinations revealed mucosal ulceration in the majority of deaths.
  
  
  CONCLUSIONS
  This case series brings to light an emerging epidemic of fatal self-poisoning in Sri Lanka from a compound that is not regulated. As deaths occur soon after ingestion, medical management of these patients is bound to be difficult.
  
  
  CONCLUSIONS
  This case series highlights a fatal mode of self-poisoning that could be controlled through regulation of the manufacture and sale of the product.
authors.affiliation: Department of Clinical Medicine and South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. indika@sactrc.org
authors.forename: I B
authors.initials: IB
authors.lastname: Gawarammana
authors.forename: P L
authors.initials: PL
authors.lastname: Ariyananda
authors.forename: C
authors.initials: C
authors.lastname: Palangasinghe
authors.forename: N G L
authors.initials: NG
authors.lastname: De Silva
authors.forename: K
authors.initials: K
authors.lastname: Fernando
authors.forename: M
authors.initials: M
authors.lastname: Vidanapathirana
authors.forename: M A
authors.initials: MA
authors.lastname: Kuruppuarachchi
authors.forename: M A A K
authors.initials: MA
authors.lastname: Munasinghe
authors.forename: A H
authors.initials: AH
authors.lastname: Dawson
mesh_terms: D000293:Adolescent; D000328:Adult; D003902:Detergents / Q000506:poisoning; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019815:Oxalic Acid / Q000506:poisoning*; D011196:Potassium Permanganate / Q000506:poisoning*; D011208:Powders; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D013188:Sri Lanka / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult
chemical_list: D003902:Detergents; D011208:Powders; D011196:Potassium Permanganate; D019815:Oxalic Acid