Aluminium Phosphide Poisoning

Mostafazadeh, Babak

doi:10.5772/30350

Cited by 15 publications

(19 citation statements)

References 57 publications

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“…Early symptoms include nausea, vomiting, retrosternal and epigastric pain, dyspnea, anxiety, agitation and smell of garlic on breath. Moreover, shock and peripheral circulatory failure are mainly imperative early signs of toxicity (Mostafazadeh, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Methemoglobinemia and Intravascular Hemolysis; Unusual Presentations of Metal Phosphides Poisoning

Wahdan

Elmadah

2016

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Introduction: Metal phosphides are highly effective insecticides and rodenticide. They are used as a cheap and effective rodenticide in developing countries. Hemolysis and methemoglobinemia are rare but reported complications of phosphide poisoning Aim of the work: The aim of this study was to detect the incidence of methemoglobinemia and intravascular hemolysis in some cases of acute phosphide poisoning. Patients and methods: A cross sectional study was conducted on 50 cases suffering from acute metal phosphide poisoning admitted to Tanta toxicology unit, from the start of October 2014 till the end of March 2015. For each case, the following were done: history taking, physical examination and laboratory investigations (including measurement of methemoglobin (Met-Hb) level, arterial blood gas analysis, routine investigations, lactate dehydrogenase enzyme and complete blood picture with reticulocytic count). Results: Eight cases (16%) had combined methemoglobinemia and hemolysis. Aluminum phosphide was the toxic agent in seven of them and zinc phosphide in only one. Three cases (6%) had methemoglobinemia alone; one of them was poisoned by aluminum phosphide and the other two by zinc phospide. Another three cases had hemolysis alone; one of them was due to aluminum phosphide toxicity and the other two were due to zinc phospidetoxicity. So the present study included a total of eleven cases (22%) of methemoglobinemia. Their median age was 27 years old, while it was 24 years for patients with normal Met-Hb level. The median delay time was 4 hours for them and 2 hours for cases with normal Met-Hb level with significant statistical differences between both. The mean Met-Hb level was 14.45 ± 9.32% and1.63 ± 0.45% in cases with high and normal Met-Hb level respectively, with a significant statistical difference between both. Furthermore, the mean oxygen saturation showed a significant statistical difference between both. In addition, the present study included a total of eleven cases (22%) of hemolysis. Their median age was 27 years old, while it was 24 years for patients with no hemolysis. The median delay time was 3 hours in them and 2 hours in cases with no hemolysis. Conclusion: It was concluded that methemoglobinemia and hemolysis can complicate the course of acute phosphide poisoning. Recommendations: Further studies on a large scale of cases of acute phosphide poisoning with assessment of the outcome of cases presented with methemoglobinemia and hemolysis and the efficacy of the available treatment for such cases are recommended. Furthermore, it is important that health care professionals be aware of these rare presentations of phosphide poisoning.

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Section: Introductionmentioning

confidence: 99%

Methemoglobinemia and Intravascular Hemolysis; Unusual Presentations of Metal Phosphides Poisoning

Wahdan

Elmadah

2016

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…Trakulsrichai et al (2017) found that most of their studied patients were exposed to less than one sachet of ZnP. The fatal dose of ALP is 150-500 mg and the person who survives after ALP exposure has mostly used an expired form (Mehrpour et al 2012;Mostafazadeh, 2012).These previous studies explained why most of ZnP studied patients in the current study were asymptomatic as they could have used either a small amount of ZnP which was less than the toxic dose or they might have mixed it with water that caused liberation of the toxic principle (phosphine gas) in air before consumption or they could have used the expired form. On the other hand, all ALP studied patients developed severe life threatening manifestations as each tablet of ALP could liberate about 1 gram of phosphine gas.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Role of Total Antioxidant Capacity and Troponin I as Possible Predictors for Phosphides -Induced Cardiotoxicity

Wahab

Shalaby

Awady

et al. 2020

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Background: Metal phosphides are type of rodenticides that are extremely lethal with low safety and high mortality rates. They are commonly used as a powerful suicidal tool in Egypt and developing countries due to its low price and easy availability. Heart is a significant target organ of acute metal phosphides toxicity, causing myocardial damage and myocarditis. Aim: The study aimed to evaluate usefulness of total antioxidant capacity (TAC) and troponin I as predictive biomarkers for phosphides induced oxidative stress and cardiotoxicity among patients admitted to the Poison Control Center Ain Shams University Hospitals (PCC-ASUH). Methods and results: A prospective study included patients of both sexes presented to the PCC-ASUH with acute metal phosphides poisoning during six months period from July to December 2017. The demographic, intoxication and clinical data were collected for every patient. On admission investigations included electrocardiogram (ECG) in addition to TAC and troponin I levels. Outcome was also recorded. This study was conducted on 188 patients of both sexes with acute metal phosphides poisoning. The patients were classified according to the Poisoning Severity Score (PSS) into three groups; mild, moderate and severe. TAC value was significantly decreased in patients who developed cardiovascular manifestations and ECG abnormalities. Serum troponin I value was significantly higher in patients who developed cardiovascular manifestations and ECG abnormalities. Conclusion: The current study concluded that TAC and troponin I levels could be useful in predicting development of oxidative damage, cardiotoxicity and mortality after acute metal phosphides poisoning. Recommendations: The present study recommended the use of TAC and troponin I as useful markers for prediction of cardiotoxicity and mortality in patients with acute metal phosphides poisoning.

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“…The first signs after severe toxicity include refractory hypotension and metabolic acidosis, within the first few hours of admission. [25]…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An Evidence-based review

Farahani

Soroosh

Marashi

2016

Indian Journal of Critical Care Medicine

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The majority of aluminum phosphide (ALP) toxicity cases are suicidal attempts. Despite advances in critical care medicine, the mortality rate of ALP remains very high. Unfortunately, knowledge on the toxicokinetics of ALP is very low. An obsolete idea was proposed that inhibition of complex IV of cytochrome C oxidase is responsible for multiorgan dysfunction. However, based on human studies, this effect might be insignificant. Thus, a novel idea proposes that the main mechanism might be vascular wall integrity disruption. The low frequency of acute toxicity and unanswered questions about the toxicokinetics and toxicodynamics has led to leaden advances of novel treatments. The aim of this review was to evaluate problems regarding current treatment protocols and propose new ideas based on updated information. For this purpose, we reviewed all available articles on the management of ALP poisoning published to date. Considering failure of conventional therapies on maintaining systolic blood pressure, correcting acid-base disturbances, and support cardiac function, the previous treatment protocols have been overruled. However, repudiate of conventional treatments in this deadly condition is not without penalties for the health-care provider. The introduction of new therapies including refuse of gastric lavage with water-soluble compounds, administration of a high molecular weight colloidal solution for fluid resuscitation and termination using sodium bicarbonate, and vasoactive agents has been prospected to improve patient survival. This protocol is in early clinical evaluation; nevertheless, it appears to improve patient's survival; hence, future randomized trials should be performed to support their effectiveness.

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Aluminium Phosphide Poisoning

Cited by 15 publications

References 57 publications

Methemoglobinemia and Intravascular Hemolysis; Unusual Presentations of Metal Phosphides Poisoning

Methemoglobinemia and Intravascular Hemolysis; Unusual Presentations of Metal Phosphides Poisoning

Assessment of the Role of Total Antioxidant Capacity and Troponin I as Possible Predictors for Phosphides -Induced Cardiotoxicity

Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An Evidence-based review

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