Microangiopathic hemolytic anemia following disseminated intravascular coagulation in aluminum phosphide poisoning

Khurana, Vishal; Is, Gambhir; Kishore, Dhiraj

doi:10.4103/0019-5359.53396

Cited by 13 publications

(11 citation statements)

References 3 publications

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“…Saleki et al [4] stated that PH3 can cause liver dysfunction, especially after the first day of poisoning, and that the main histopathologic changes found were fine cytoplasmic vacuolization of hepatocytes and sinusoidal congestion. A similar condition was recorded in a case reported by Khurana et al [5], who found elevated transaminase levels; Karanth and Nayyar [6] recorded severe hepatic dysfunction in their cases. Musshoff et al [7] found congestion, edema and centrizonal necrosis of the liver from histopathological examination.…”

Section: Discussionsupporting

confidence: 82%

A Suicide Attempt Using Zinc Phosphide (A Case Study)

Coşkun¹,

Atalay²,

Dağli³

et al. 2014

Ann Clin Anal Med

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ÖzetÇinko Fosfür, fare mücadelesinde zehirli buğday üretimi için kullanılır ve rodentisitin aktif maddesidir. İntihar amacıyla tarım ilacı [Zinc Phosphide (Zn3P2)] içen 17 yaşındaki erkek olgu acil serviste görüldüğünde: Genel durumu kötü, bilinci kapalı, kusmuğu ve cildinde sarımsak kokusu ve ileri derecece asidozu mevcuttu. Semptomatik tedavi uygulanan ve mekanik ventilatorde takip edilen olgu yatışının 5. günü psikiyatri kliniğine devir edildi. Anahtar KelimelerÇinko Fosfür; Suisid; Sarımsak Kokusu AbstractZinc phosphide is a toxin that is added to wheat for use in rodent control and is the active ingredient of rodenticide. A 17 year-old male attempted suicide by drinking pesticide [Zinc PHOSPHIDE (Zn3P2)] and was subsequently admitted to the emergency department: the patient's general condition was poor, he was unconscious and vomiting, the skin had a garlic odor and advanced acidosis was present.The patient was treated symptomatically, followed by mechanical ventilation, and was transferred to a psychiatric clinic on the fifth day.

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Section: Discussionsupporting

confidence: 82%

A Suicide Attempt Using Zinc Phosphide (A Case Study)

Coşkun¹,

Atalay²,

Dağli³

et al. 2014

Ann Clin Anal Med

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“…This case raised our attention to the possibility of the development of disseminated intravascular coagulopathy (DIC) as recorded in previous studies [39,42,46,[50][51][52]. Proudfoot in 2009 [39] attributed its occurrence to the highly toxic phosphine gas not to the metal phosphides.…”

Section: Discussionmentioning

confidence: 86%

Zinc phosphide toxicity with a trial of tranexamic acid in its management

Naggar

Mahdy

2011

Journal of Advanced Research

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Zinc phosphide is a highly effective rodenticide used widely to protect grain in stores and domestically to kill rodents. Acute poisoning may be direct by ingestion or indirect through accidental inhalation of phosphine gas generated during its use. This study aims to identify the patterns of intoxication with zinc phosphide among Egyptian patients admitted to the National Egyptian Center of Clinical and Environmental Toxicological Research (NECTR); to study the role of antifibrinolytics in management of zinc phosphide toxicity; and to publish the results of the study, which include recommendations for action towards planning prevention and education programs. The study provides descriptive data and analysis of 188 cases admitted to the NECTR with acute zinc phosphide poisoning over a period of 22 months. Results show that poisoning is more common among females (60.6% of cases) than males (39.4%); the mean age is nearly 21 years old. The most common cause of poisoning is suicidal attempts (83.6%) followed by accidental exposure (16.4%). The most common causative factors that lead to self-poisoning are marital disharmony, economic hardship, social problems and scolding from other family members. Signs and symptoms of toxicity include gastrointestinal disturbances, respiratory compromise and changes in mental status. Other features include disseminated intravascular coagulation, hepatic and renal impairment. Metabolic disturbances had been reported. Death can result immediately due to pulmonary edema or delayed due to cardiotoxicity. Patients must be admitted to hospital and observed for at least 3 days. Symptomatic and supportive care is the mainstay of therapy. Zinc phosphide poisoning requires gastric lavage with excessive sodium bicarbonate solution. Tranexamic acid -an antifibrinolytic

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“…[404546] Other uncommon findings in AlP poisoning are intravascular hemolysis, acute adrenocortical insufficiency, hepatitis, acute tubular necrosis, pancreatitis, hypo- or hyperglycemia, methhemoglobinemia, microangiopathic hemolytic anemia and disseminated intravascular coagulation. [3747–53] In follow-up among survivors, one-third of the patients had dysphagia due to esophageal complications, including esophageal stricture or tracheo-esophageal fistula. [54]…”

Section: Clinical Featuresmentioning

confidence: 99%

Managing aluminum phosphide poisonings

Gurjar

Baronia

Azim

et al. 2011

J Emerg Trauma Shock

150

125

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Aluminum phosphide (AlP) is a cheap, effective and commonly used pesticide. However, unfortunately, it is now one of the most common causes of poisoning among agricultural pesticides. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. The mechanism of toxicity includes cellular hypoxia due to the effect on mitochondria, inhibition of cytochrome C oxidase and formation of highly reactive hydroxyl radicals. The signs and symptoms are nonspecific and instantaneous. The toxicity of AlP particularly affects the cardiac and vascular tissues, which manifest as profound and refractory hypotension, congestive heart failure and electrocardiographic abnormalities. The diagnosis of AlP usually depends on clinical suspicion or history, but can be made easily by the simple silver nitrate test on gastric content or on breath. Due to no known specific antidote, management remains primarily supportive care. Early arrival, resuscitation, diagnosis, decrease the exposure of poison (by gastric lavage with KMnO4, coconut oil), intensive monitoring and supportive therapy may result in good outcome. Prompt and adequate cardiovascular support is important and core in the management to attain adequate tissue perfusion, oxygenation and physiologic metabolic milieu compatible with life until the tissue poison levels are reduced and spontaneous circulation is restored. In most of the studies, poor prognostic factors were presence of acidosis and shock. The overall outcome improved in the last decade due to better and advanced intensive care management.

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Microangiopathic hemolytic anemia following disseminated intravascular coagulation in aluminum phosphide poisoning

Cited by 13 publications

References 3 publications

A Suicide Attempt Using Zinc Phosphide (A Case Study)

A Suicide Attempt Using Zinc Phosphide (A Case Study)

Zinc phosphide toxicity with a trial of tranexamic acid in its management

Managing aluminum phosphide poisonings

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