Aluminium phosphide (ALP) poisoning is a commonly encountered poisoning in emergency departments in most developing countries. Many papers have revealed metabolic derangements in this poisoning and also examined contributing factors leading to death, but only few have reported physical damage. Some case reports have described a complication that has been frequently termed ‘ignition’. The exact mechanism of this phenomenon has not been fully elucidated. An exothermic reaction during therapeutic administration of chemicals may contribute to this problem, but the incidence has occurred in the absence of treatment or drug administration. Here, we report a 34-year-old woman with ALP poisoning who presented with hot charcoal vomitus, a sign of internal thermal event, leading to the thermal burning of the patient's face and internal damage resulting in death. We reviewed all reported cases with similar complication to demonstrate varied characteristics of patients and to propose the possible mechanisms leading to this event.

In patients resuscitated from acute opioid overdose, short-term outcomes are similar for patients with pure opioid overdose and multidrug intoxications. A history of cointoxication cannot be used to identify high-risk patients who require more intensive ED monitoring or prolonged observation.

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A bstract Background Toxicity and side effects of long-term use of opioids are well studied, but little information exists regarding electrophysiological disturbances of opium consumption. While natural opium has been regarded safe to a great extent among traditional communities, concerns are emerging owing to the available evidence of QT prolongation that have been exposed during recent outcome surveillance of patients under opioid use. Potential QT prolonging interactions would raise a higher level of such concern in opium users during COVID pandemic and warrant attention. Materials and methods This study was designed to detect the prevalence of QTc prolongation among opium users and nonusers. Two groups were compared with regard to gender, age, and median QTc interval. Normal and prolonged QTc intervals of user group were compared with respect to age, sex, dose of opium consumption, and duration of opium consumption. Results 123 opium users and 39 controls were investigated. Median QTc interval in opium user and non-user group was 460 vs 386 milliseconds, respectively ( p value < 0.001). In all, 59.3%, (95% CI: 50.51–67.62%) of cases and none of non-user had prolonged QTc interval ( p value < 0.001). There was no significance between normal and prolonged QTc intervals with respect to dose and duration of opium use. Conclusion This study indicated that opium consumption is associated with QTc prolongation. This prolongation does not relate to dose and duration of opium use. Further study is propounded to assess the clinical significance of these results and to determine risk rating of opium compared to other opioids in this regard. How to cite this article Javadi HR, Mirakbari SM, Allami A, Yazdi Z, Katebi K. Opium-associated QT Interval Prolongation: A Cross-sectional Comparative Study. Indian J Crit Care Med 2021;25(1):43–47.

I read with great interest the paper entitled "A review of aluminium phosphide poisoning and a flowchart to treat it" published in your journal by Hashemi-Domeneh et al. (1). This article has tried, and failed, to review up-to-date knowledge related to aluminium phosphide (ALP) poisoning and propose an easy-to-use management paradigm for health professionals. In addition, it has largely ignored the existing evidence of the different aspects of ALP poisoning beyond metabolism-based consequences. It has therefore failed to answer the question why the mortality rate remains high, even with such considerable advances in treatment protocols. First, the paper has undermined the significance of local thermal injuries in different settings of ALP poisoning. These complications have frequently been reported in the literature and are believed to play a substantial role in the unfavourable outcome (2). Second, the paper is not consistent with two of the three pillars of evidence-based medicine, including clinical expertise and best available evidence (3). Expert opinions and current evidence propose three readily available and feasible recommendations that should be included in the flowchart described in this paper. These are as follows: (A) Do not administer potassium permanganate in gastrointestinal (GI) decontamination. It induces an exothermic reaction that leads to burning and local thermal injuries, resulting in haemorrhages, hypotension, and death (2, 4-5). In addition, it is a strong oxidising agent that causes hemolysis and methemoglobinemia, which contribute to the deterioration of the course of the patient's recovery (6). (B) Do not suction and lavage via a nasogastric tube, as it increases negative pressure in the stomach, which, in turn, provokes internal gas ignition (2, 7-8). (C) Administer an intravenous (IV) lipid emulsion (5). The circulating toxic phosphine is trapped in a blood lipid pool, thereby hindering its site toxic effects. I thank you for your attention to my viewpoints.