Assessment of Intravenous Lipid Emulsion as an Adjuvant Therapy in Acute Aluminum Phosphide Poisoning: A randomized Controlled Trial

Abstract

Background: Aluminum phosphide (ALP) is efficient rodenticide and insecticide. The increased incidence of acute ALP poisoning and its high mortality is a challenge for health professionals, there is no specific antidote and the treatment is mainly supportive. Aim of the work: The aim of this study was to evaluate the efficacy and safety of intravenous lipid emulsion as an adjuvant therapy for acute ALP poisoning. Patients and methods: The present study was carried out on fifty patients with acute ALP poisoning admitted at Poison Control Unit, Tanta University Emergency Hospital, throughout a period from the start of December 2016 till November 2017. The study participants were randomly allocated into 2 equal groups (25 patients each): The experimental group (received ILE 20% at a rate of 10ml/h IV infusion plus the conventional treatment of ALP poisoning), and the control group (received the conventional treatment only). Results: The number of deaths in the experimental group was lower than the control group, but it did not reach a significant level. The need for intubation and mechanical ventilation was significantly lower in the experimental group compared to the control group. Conclusion: The administration of ILE 20% in acute ALP poisoning at a rate of 10ml/h IV infusion is a safe therapy. Moreover, the adjuvant ILE use along with the conventional supportive treatment could have a therapeutic effect in ALP poisoned patients.

Lipid emulsion for xenobiotic overdose: PRO

“…Beyond LAST, emerging RCTs 56–63 are providing high‐level evidence for ILE in treatment of other, primarily oral, drug overdoses. It is possible that there is a threshold‐based effect of ILE (at ~4 mL/kg; see Figure 2), and the treatment benefit may extend beyond lipophilic substances as demonstrated in clinical trials of metoprolol 64 and aluminium phosphide 59 . As a field, we must continue to support RCTs of ILE while using alternative approaches to examine the efficacy of ILE in severe LAST and other toxic overdoses that are ill‐suited for RCTs.…”

“…Log D at pH 7.4) (Figure 2A,B). Following on this dose assertion, the clinical benefit of ILE may extend beyond lipophilic substances as demonstrated by the clinical trials of metoprolol 64 and aluminium phosphide 59 . Finally, many trials originate from developing countries afflicted by high rates of toxicity from pesticides and antipsychotics.…”

“…Nevertheless, volunteer studies of subtoxic doses confirm the mechanistic benefit of ILE in bupivacaine, 32 ropivacaine, levobupivacaine 33 and lidocaine. 55 Further, RCTs have emerged in the setting of non-LAST, [56][57][58][59][60][61][62][63] specifically demonstrating a clinical benefit of ILE in poisoning from pesticides, [57][58][59][60] antipsychotics (primarily clozapine), 61,62 tramadol 63 and metoprolol. 64 There are several conclusions to be drawn from these clinical trials [56][57][58][59][60][61][62][63] and volunteer studies 32,33,55,64 (Table 1).…”

“…55 Further, RCTs have emerged in the setting of non-LAST, [56][57][58][59][60][61][62][63] specifically demonstrating a clinical benefit of ILE in poisoning from pesticides, [57][58][59][60] antipsychotics (primarily clozapine), 61,62 tramadol 63 and metoprolol. 64 There are several conclusions to be drawn from these clinical trials [56][57][58][59][60][61][62][63] and volunteer studies 32,33,55,64 (Table 1). First, ILE causes minimal complications.…”

“…Following on this dose assertion, the clinical benefit of ILE may extend beyond lipophilic substances as demonstrated by the clinical trials of metoprolol 64 and aluminium phosphide. 59 Finally, many trials originate from developing countries afflicted by high rates of toxicity from pesticides and antipsychotics. A quick perusal of clinicaltrials.gov identifies multiple subsequent studies in process; these assess the utility of ILE for antipsychotics (NCT04807634), pesticides (NCT05006638) and fatsoluble drugs (NCT05148611), all of which are occurring in non-Western countries.…”