Introduction: Emerging chemicals including pharmaceuticals, pesticides, and household agents—are increasingly recognized as environmental contaminants with potential for adverse health effects. Human poisoning events serve as sentinel indicators of exposure. This prospective study aimed to evaluate the pattern, environmental sources, and acute health outcomes of poisoning by emerging chemicals in a tertiary care hospital in South India.

Methods: A prospective observational study was conducted from January 2020 to July 2023 at the Emergency Department of Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu, India . Consecutive patients presenting with acute poisoning were enrolled. Data on demographic characteristics, poisoning agent, exposure route, time to presentation, clinical management, and outcomes were collected and analyzed.

Results: Among 81 prospectively enrolled patients, pharmaceutical overdose was the most frequent exposure (34.6%), followed by organophosphorus pesticides (18.5%) and rat killer (13.6%). Intentional ingestion accounted for 67.9% of cases. Most patients (76.5%) arrived within 4 hours of exposure. Activated charcoal was administered in 39.5% of cases; specific antidotes included N-acetylcysteine (18.5%) and atropine (8.6%). All patients recovered fully, with no mortality in the prospective cohort.

Conclusion: Prospective surveillance reveals that pharmaceuticals and pesticides are the predominant emerging chemicals causing acute poisoning. The high proportion of intentional ingestion highlights the intersection of environmental availability and mental health. Reducing the burden requires integrated strategies: stricter pesticide regulation and community education.