Toxicological cases in South Africa are largely attributed to pharmaceuticals, drugs of abuse, pesticides, plants, solvents and metals. Unfortunately cases are not well documented and the poison info centres do not deal with the majority of cases.
Factors such as natural diseases, chronic pain and mental health problems contribute to prescription drug overdose. It is for this reason that prescription drugs remain the most common compounds detected in toxicology cases.
Pharmaceuticals most commonly detected include theophylline - used to treat asthma symptoms; amitriptyline - an antidepressant drug; carbamazepine - anti-epileptic drug; antihistamine - cyclizine used to treat hay fever and orphenadrine, which is used in combination with aspirin as a muscle relaxant. There has been an increase in the number of cases where antidepressants have been detected, which is not surprising as the pressures of life are on the increase.
Pesticides, paraffin and lead
Organophosphorus and carbamate pesticides, notably Aldicarb, which is widely used as a rodenticide, are also commonly detected.
However, the most common cause of accidental poisoning in South Africa is paraffin ingestion and each year, approximately 20,000 children suffer from the effects of this. Children under five years old are at the highest risk. The introduction of child resistant safety caps on paraffin bottles, (at the instigation of the Paraffin Safety Association of South Africa) has led to the decrease in the number of cases being reported.
A large number of South African children are said to be exposed to lead from non-petrol sources, including paint, and from industrial usage. This problem was partially addressed by removing the lead from paints used to paint toys.
There is also a notable increase in the number of toxicological poisonings in which drugs of abuse are detected. This increase appears to be similar to that reported worldwide. The drugs of abuse most commonly detected are methaqualone, cocaine and crack cocaine, amphetamines and heroin. Usually there is the usage of multiple illicit substances and/or alcohol simultaneously. Methaqualone and alcohol are commonly detected along with one or more drugs of abuse. Methaqualone is commonly known to the South African public as Mandrax and is manufactured locally. Amphetamines include crystal meth and ecstasy.
Berries and herbal medicines
Young children are often admitted to hospital after ingesting poisonous plants (mostly berries, which look edible). There are also cases of people being admitted after herbal medicine intoxication. Although only a handful of herbal remedies prescribed by traditional healers are actually toxic, the problem lies therein that these remedies contain no prescription insert as to dosage, and the constituents are also not listed. Another problem is that there could be interactions between the herbal remedies and some pharmaceutical substances. Herbal medicines are seen as natural by most people. However, for diseases that have no cure (such as HIV/Aids) people will take strange medications out of desperation.
Poisonings due to snakebites, spider bites or scorpion stings are very rare. However, people should be aware that black button spiders found country-wide, often inside homes, have neurotoxic poisons. Scorpions with thin pincers and thick tails are more venomous than those with thin tails and large pincers. These scorpions possess neurotoxic venom.