Supportive Measures in the Treatment of Aluminum Phosphide Poisoning as a Trial to Reduce Mortality at Assiut University Hospital, Egypt
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Abstract
Aluminum phosphide (AlP) poisoning is a major problem, accounting
for many Emergency Unit visits and hospitalization with
increasing incidence of AlP toxicity in the last few years. In spite
of the progress achieved in the field of toxicology and associated
therapies, AlP is still responsible for a high rate of mortality due to
the rapid onset of life-threatening symptoms, ineffective treatment
and inadequate data on the efficacy of therapeutic interventions.
AlP poisoning is a serious medical emergency demanding early and
adequate management.
In this prospective study of AlP toxicity, 44 patients admitted to
emergency unit of Assiut university hospital in the period from 1st
January to 30th June 2016 were included.
There were 28 males (68.2%) and 16 females (31.8%). The majority
of the cases were in the age group from 21 to 30 years (n=28,
54.6%). Thirty-six (81.8%) of admitted patients were from rural
areas. Suicidal intake was the main mode of toxicity in 81.8% of
cases. About 41% of the cases were shocked at their presentation
and had metabolic acidosis. The mortality rate was 45.5%. The incidence
of death in patients treated with N-acetyl cysteine to the
incidence of death in non-treated patients was 1:12.
AlP poisoning needs more attention due to associated fatality,
the absence of an antidote, and a high number of youth victims.
Supportive measures are vital in these patients. N-acetyl cysteine
has a protective effect.
Keywords
Forensic Science, Aluminum Phosphide Poisoning, Cardiotoxicity, Pesticides, Emergency, N-acetyl cysteine.
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References
Hajouji MI, Oualili L, Abidi K, Abouqal R, Kerkeb O,
Zeggwagh AA. Severity factors of aluminium phosphide
poisoning (Phostoxin). Ann Fr Anesth Reanim.
; 25 (4):382-5.
Proudfoot AT. Aluminium and zinc phosphide poisoning.
Clinl toxicol. 2009;47(2):89-100. https://doi.
org/10.1080/15563650802520675
Moghadamnia, A. A. (2012). An update on toxicology
of aluminum phosphide. DARU J Pathol Microbiol,
;20(1), 25. https://doi.org/10.1186/2008-2231-20-
Sinha US, Kapoor AK, Singh AK, Gupta A, Mehrotra
R. Histopathological changes in cases of aluminium
phosphide poisoning. Indian J Pathol Microbiol.
;48(2):177-80.
Masoud RA and BArghash SS. Laboratory prognostic
potential for acute aluminum phosphide poisoning. Al-
Azhar Assiut Medical Journal. 2013, 11(3):213-8.
Agrawal VK, Bansal A, Singh RK, Kumawat BL,
Mahajan P. Aluminum phosphide poisoning: Possible
role of supportive measures in the absence of specific
antidote. Indian J Crit Care Med. 2015;19(2):109-12.
https://doi.org/10.4103/0972-5229.151019
Azad A, Lall SB, Mittra S. Effect of N-acetylcysteine
and L-NAME on aluminium phosphide induced cardiovascular
toxicity in rats. Acta pharmacologica Sinica.
;22(4):298-304.
Bogle RG, Theron P, Brooks P, Dargan PI, Redhead
J. Aluminium phosphide poisoning. Emerg
Med J. 2006;23(1):e03. https://doi.org/10.1136/
emj.2004.015941
Moghadamnia AA, Rahmani FA, Javadian SH, Dibavand
N. Aluminium phosphide poisoning in mice and
the procedure for its managements. J Babol Univ Med
Sci. 2000; 2:25–33
Chugh SN. Aluminium phosphide poisoning: present
status and management. J Assoc Physicians India.
;40(6):401-5.
Hassanian-Moghaddam H, Pajoumand A. Two years
epidemiological survey of Aluminium Phosphide poisoning
in Tehran. Iranian J Toxicol. 2007;1(1):35-9.
Raizada A, Kalra OP, Khaira A, Yadav A. Profile
of hospital admissions following acute poisoning
from a major teaching hospital in North India. Tropical
doctor. 2012;42(2):70-3. https://doi.org/10.1258/
td.2011.110398
Louriz M, Dendane T, Abidi K, Madani N, Abouqal
R, Zeggwagh AA. Prognostic factors of acute aluminum
phosphide poisoning. Indian J Med Sci.
;63(6).227–34.
Taghaddosi Nejad F, Banagozar Mohammadi A,
Behnoush B, Kazemifar A, Zaare Nahandi M, Dabiran
S, Jamalian M. Predictors of poor prognosis in
aluminum phosphide intoxication. Iranian J Toxicol.
;6(16):610-4.
Sulaj Z, Drishti A, Çeko I, Gashi A, Vyshka G. Fatal
aluminum phosphide poisonings in Tirana (Albania),
–2013. DARU J Pharmaceutical Sci. 2015;23(1):8.
https://doi.org/10.1186/s40199-015-0090-0
Soltaninejad K, Beyranvand MR, Momenzadeh SA,
Shadnia S. Electrocardiographic findings and cardiac
manifestations in acute aluminum phosphide poisoning.
J Forensic Legal Med. 2012;19(5):291-3. https://
doi.org/10.1016/j.jflm.2012.02.005
Rahbar Taramsari M, Badsar A, Shafaghi A, Namakchian
Namakin M, Ebrahimi H, Fallah Karkan M.
Alteration in Liver Enzymes in Aluminum Phosphide
Poisoning, A Retrospective Study. Iranian J Toxicol.
;7(21):854-7.
Khan MU. Mortality Indicators of Aluminium Phosphide
Poisoning: Experience at DHQ Hospital Rawalpindi.
Ann Pak Inst Med Sci. 2015;11(2):64-6.
Khodabandeh F, Kahani A, Soleimani G. The study of
fatal complications of “rice tablet “poisoning. Iranian J
Forensic Med. 2014;20(2):27-36.
Saha JK, Azad KA, Hossain MZ, Amin MR, Ahmed
M, Ahsan HM, Rahman S. Aluminium phosphide poisoning
cases in a tertiary care hospital. J Dhaka Med
Coll. 2014;23(1):3-6. https://doi.org/10.3329/jdmc.
v23i1.22685
Gunnell D, Eddleston M. Suicide by intentional ingestion
of pesticides: a continuing tragedy in developing
countries. Int J Epidemiol.2003; 32(6): 902–9. https://
doi.org/10.1093/ije/dyg307
Anand R, Binukumar BK, Gill KD. Aluminum phosphide
poisoning: an unsolved riddle. J Applied Toxicol.
Aug;31(6):499-505. https://doi.org/10.1002/
jat.1692
Mathai A, Bhanu MS. Acute aluminium phosphide
poisoning: Can we predict mortality?. Indian J Anaesth.
;54(4):302. https://doi.org/10.4103/0019-
68372
Chugh SN, Pal R, Singh V, Seth S. Serial blood phosphine
levels in acute aluminium phosphide poisoning. J
Assoc Physicians India. 1996;44(3):184-5.
Gurjar M, Baronia AK, Azim A, Sharma K. Managing
aluminum phosphide poisonings. Journal of Emergencies,
Trauma and Shock. 2011;4(3):378. https://doi.
org/10.4103/0974-2700.83868
Soltaninejad K, Nelson LS, Bahreini SA, Shadnia S.
Fatal aluminum phosphide poisoning in Tehran-Iran
from 2007 to 2010. Indian J Med Sci. 2012;66(3-4):66-
Akkaoui M, Achour S, Abidi K, Himdi B, Madani
A,Zeggwagh AA, Abouqal R. Reversible myocardial
injury associated with aluminum phosphide poisoning.
Clin Toxicol. 2007;45(6):728-31. https://doi.
org/10.1080/15563650701517350
Farnaghi F, Talaie H, Pournasiri Z, Sadeghi R, Owliaey
H, Hassanian-Moghaddam H, Shadnia S. Effect of Aluminium
Phosphide Poisoning on Blood Cortisol Level.
Iranian J Toxicol. 2013;6(19):746-50.
Shadnia S, Mehrpour O, Soltaninejad K. A simplified
acute physiology score in the prediction of acute aluminum
phosphide poisoning outcome. Indian J Med
Sci. 2010;64(12):532. https://doi.org/10.4103/0019-
75928
Shadnia S, Sasanian G, Allami P, Hosseini A, Ranjbar
A, Amini-Shirazi N, Abdollahi M. A retrospective
-years study of aluminum phosphide poisoning
in Tehran: opportunities for prevention.
Hum Exp Toxicol. 2009;28(4):209-13. https://doi.
org/10.1177/0960327108097194
Gupta MS, Malik A, Sharma VK. Cardiovascular manifestations
in aluminium phosphide poisoning with special
reference to echocardiographic changes. J Assoc
Physicians India. 1995;43(11):773-4.
Chugh SN, Ram S, Arora B, Malhotra KC. Incidence &
outcome of aluminium phosphide poisoning in a hospital
study. Indian J Med Res. 1991;94:232-5.
Gupta S and Ahlawat SK. Aluminum phosphide poisoning
review. J Toxicol Clin Toxicol.1995;33:19-24.
https://doi.org/10.3109/15563659509020211
Singh S, Bhalla A, Verma SK, Kaur A, Gill K. Cytochrome-
c oxidase inhibition in 26 aluminum phosphide
poisoned patients. Clin Toxicol. 2006;44(2):155-8.
https://doi.org/10.1080/15563650500514467
Agarwal A, Robo R, Jain N, Gutch M, Consil S, Kumar
S. Oxidative stress determined through the levels of antioxidant enzymes and the effect of N-acetylcysteine
in aluminum phosphide poisoning. Ind J Crit Care
Med.. 2014;18(10):666. https://doi.org/10.4103/0972-
142176
Bhat S, Kenchetty KP. N-Acetyl Cysteine in the Management
of Rodenticide Consumption—Life Saving?.
J Clin Diagn Res. 2015;9(1):OC10. https://doi.
org/10.7860/JCDR/2015/11484.5455
Moghadamnia A, Abdoilahi M. An epidemiological
study of poisoning in northern lslamic. East Mediterr
Health J. 2002;8(1):88-94.
Siddaiah LM, Adhyapak SM, Jaydev SM, Shetty GG,
Varghese K, Patil CB, Iyengar SS. Intra-aortic balloon
pump in toxic myocarditis due to aluminum phosphide
poisoning. J Med Toxicol. 2009;5(2):80-3. https://doi.
org/10.1007/BF03161093
Singh D, Dewan I, Pandey AN, Tyagi S. Spectrum of
unnatural fatalities in the Chandigarh zone of northwest
India–a 25 year autopsy study from a tertiary
care hospital. J Clin Forensic Med. 2003;10(3):145-52.
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