Acute lethal poisonings in children: a 10-year retrospective study of the Moscow Region, Russia

Semyon S. Plis
Department of Complex Examinations, Moscow Region Bureau of Forensic Medical Examination, Moscow; Department of Forensic Medicine, Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russian Federation.

Olesya V. Veselkina
Department of Forensic Medicine, Moscow Regional Research and Clinical Institute (MONIKI), Moscow; Department of Innovative Health Care Management, Academy of Postgraduate Education under FSBU FSCC of FMBA of Russia, Moscow, Russian Federation.

Vladimir A. Klevno
Department of Forensic Medicine, Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russian Federation.

Vasiliy V. Vlassov
Department of Health Care Management and Economics, National Research University Higher School of Economics, Moscow, Russian Federation.


Background: Poisoning is a critical public health problem. Toxic substances differ across time, region and age. Little is known about poisoning in Russia, and even less is known about lethal poisoning in children in Russia. We aimed to describe the characteristics of cases of lethal poisoning in children and adolescents.

Design and methods: Our retrospective study was based on autopsy reports from archives of the Moscow Region Bureau of Forensic Medical Examination for the period of 2009 to 2018.

Results: A total of 438 lethal poisoning cases were recorded. The average age of the poisoned children was 11.3 years. Deaths predominantly occurred in boys, mostly due to the higher frequency of poisoning with household and technical chemicals (p<0.01). Accidental deaths were also higher in males (p < 0.01). Therapeutic drug poisoning (p<0.01) and suicide (p < 0.01) were more frequent in females.

The leading cause of lethal poisoning in children was exposure to carbon monoxide, especially in children aged 5 to 9 years (p<0.01) and 1 to 4 years (p<0.01). Carbon monoxide poisoning occurred more often in winter (p<0.01). Regarding the structure of poisoning with household and technical chemicals, the most frequent was poisoning by a mixture of utility gases.

Conclusion: Our study shows that carbon monoxide poisoning is a serious problem in the region. This may be associated with the ongoing use of individual heating systems. A significant increase in the frequency of fatal poisoning by chemicals, especially by propane-butane gas mixtures while sniffing, has become a disturbing trend.


GBD 2017 DALYs, HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1859-922. DOI:

Sleet DA. The global challenge of child injury prevention. Int J Environ Res Public Health 2018;15:1921. DOI:

Gummin DD, Mowry JB, Spyker DA, et al. 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol (Phila) 2018;56:1213-415. DOI:

39th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 21-24 May 2019, Naples, Italy. Clin Toxicol 2019;57:423-602.

Karadeniz H, Birincioglu I, Turna O, et al. Fatal poisoning of chilhood in the Eastern Black Sea region of Turkey (2009-2013). J Forensic Leg Med 2015;34:109-12. DOI:

Jönsson AK, Holmgren P, Druid H, et al. Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002-2003. Forensic Sci Int 2007;169:101-7. DOI:

Wang L-L, Zhang M, Zhang W, et al. A retrospective study of poisoning deaths from forensic autopsy cases in northeast China (Liaoning). Forensic Leg Med 2019;63:7-10. DOI:

Costa M, Silva BS, Real FC, et al. Epidemiology and forensic aspects of carbon monoxide intoxication in Portugal: A three years' analysis. Forensic Sci Int 2019;299:1-5. DOI:

Klevno VA, Maksimov AV, Kononov RV, et al. [Forensic medical evaluation of toxicological effects of ethanol among children].[Article in Russian with English Abstract]. Russian J Forensic Med 2017;3:4-12. DOI:

Vrkic Boban I, Vrca A, Saraga M. changing pattern of acute alcohol intoxications in children. Med Sci Monit 2018;24:5123-31. DOI:

Pawlowicz U, Wasilewska A, Olanski W, et al. Epidemiological study of acute poisoning in children: a 5-year retrospective study in the Paediatric University Hospital in Bialystok, Poland. Emerg Med J 2013;30:712-6. DOI:

Ulseth ET, Freuchen A, Köpp UMS. [Acute poisoning among children and adolescents in southern Norway]. [Article in Norwegian, English]. Tidsskr Nor Laegeforen 2019;139:1116.

Gheshlaghi F, Piri-Ardakani MR, Yaraghi M, et al. Acute poisoning in children; a population study in Isfahan, Iran, 2008-2010. Iran J Pediatr 2013;23:189-93.

Mintegi S, Fernández A, Alustiza J, et al. Emergency visits for childhood poisoning: a 2-year prospective multicenter survey in Spain. Pediatr Emerg Care 2006;22:334-8. DOI:

Tyrrell EG, Kendrick D, Sayal K, et al. Poisoning substances taken by young people: a population-based cohort study. Br J Gen Pract 2018;68:e703-e10.

Macnow TE, Waltzman ML. Carbon monoxide poisoning in children: Diagnosis and management in the emergency department. Pediatr Emerg Med Pract 2016;13:1-24.

Korppoo A, Korobova N. Modernizing residential heating in Russia: End-use practices, legal developments, and future prospects. Energy Policy 2012;42:213-20. DOI:

Filippov SP. Development of centralized district heating in Russia. Thermal Engineering 2009;56:985. DOI:

Winstanley EL, Stover AN. The Impact of the opioid epidemic on children and adolescents. Clin Ther 2019;41:1655-62. DOI:

Berta GN, Di Scipio F, Bosetti FM, et al. Childhood acute poisoning in the Italian North-West area: a six-year retrospective study. Ital J Pediatr 2020;46:83. DOI: