Acute aluminium phosphide poisoning, what is new?

Singh, Yatendra; Joshi, S. C.; Satyawali, Vivekanand; Gupta, Abhisek

doi:10.4103/1110-7782.145298

Cited by 37 publications

(41 citation statements)

References 24 publications

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“…Owing to increased agricultural and nonagricultural use, easy availability in markets as well as low price, phosphide is emerging as a common self-poisoning agent, with increasing number of cases in the past four decades. On the other hand, exposure is uncommonly accidental and rarely homicidal (El-Naggar and El-Mahdy, 2011;Singh et al, 2014). M Acute phosphides poisoning is due to either direct salt ingestion or indirect inhalation of phosphine gas generated during approved use.…”

Section: Introductionmentioning

confidence: 99%

The Potential Role of S-100β Protein in Evaluation of CNS Affection and Prediction of Mortality in Acute Phosphides Intoxication

Shahin

Abuelfadl

Zaki

2016

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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All rights reserved. AbstractPhosphides poisoning is a commonly encountered poisoning in most developing countries and is emerging as a common self-poisoning agent. Over the past 20 years, biochemical markers of brain damage have been increasingly studied as potential tools for prognostic evaluation. S-100β protein is the β-subunit of a calcium binding protein present mainly in glial and Schwann cells. The current study was conducted to evaluate central nervous system affection and the prognostic value of S-100β protein for prediction of mortality after acute phosphides intoxication. Twenty nine patients admitted to Poison Control Unit (Emergency Hospital, Tanta University) suffering from acute phosphide poisoning in nine months period were included in this study. For all patients sociodemographic, clinical and toxicological data were explored. One milliliter venous blood was withdrawn for analysis of S-100β protein level. Primary outcome included mortality. Meanwhile, secondary outcomes included GCS, hypotension and length of hospital stay. There was statistical significant difference between survivor patients and non-survivor patients regarding blood pressure. Meanwhile, no statistical significant difference was noticed between survivors and non-survivors in either GCS, pulse or duration of hospital stay. Toxicological data of the participant patients revealed that (96.6%) of patients were in suicidal attempts by oral route. Zink phosphide was identified in (75.9%) of patients, while, aluminum phosphide was recognized in (24.1%) patients. Serum level of S-100β concentrations was significantly increased in phosphide intoxicated patients compared to the reference value for detection of injury to neural tissue (0.1 µg/L). There was significant negative statistical correlation between serum S-100β concentrations and GCS. Analysis of (ROC) curve of serum S-100β level as a predictor of mortality showed (AUC) = 0.956, P <0.0001* at a cut off value > 1.762 ug/l, serum S100β had a sensitivity of 100% and a specificity 95%. (PPV) was 95%, while (NPV) was 100%.

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Section: Introductionmentioning

confidence: 99%

The Potential Role of S-100β Protein in Evaluation of CNS Affection and Prediction of Mortality in Acute Phosphides Intoxication

Shahin

Abuelfadl

Zaki

2016

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…It is used for crops protection during storage and transportation (Bumbrah et al, 2012). Acute AlP toxicity is associated with high risk of morbidity and mortality (Singh et al, 2014). Therefore, the current study was designed to evaluate role of clinical data, laboratory investigations and ECG changes in mortality prediction in acute AlP poisoning.…”

Section: Discussionmentioning

confidence: 99%

Clinical Data, Laboratory Investigations and Electrocardiographic Changes as Predictors of Mortality in Acute Aluminum Phosphide Poisoning

Wahdan

Khalifa

2020

Mansoura Journal of Forensic Medicine and Clinical Toxicology

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Aluminum phosphide (AlP) is a fumigant widely used in Egypt. Limited data is available about mortality prediction in AlP poisoned patients. This work was designed to evaluate role of clinical data, laboratory investigations and ECG findings in predicting mortality in these cases. A cohort retrospective study was conducted on 113 cases of AlP poisoning admitted to Tanta University Poison Control Center. History, clinical data and results of laboratory investigations were recruited. The mortality rate was 68.1%. There was a significant difference between survivors and non-survivors as regards mode of poisoning, GCS, vital signs (except heart rate), ECG abnormalities, pH, HCo3, K, creatine level and white blood cell count. The multivariate analysis logistic regression revealed that ECG changes and pH level were the only independent variables that can predict mortality. Analysis of receiver operating curve of blood pH level revealed a good area under the curve (AUC) of 0.881. At a cut off value of ≤7.28 the blood pH level had a sensitivity of 71.43. It was concluded that AlP poisoning causes high mortality rate. Mortality could be predicted by ECG changes and blood pH level. At a cut off value of ≤7.28 the blood pH level was able to predict mortality. ECG assessment and blood pH monitoring are highly recommended in cases of AlP poisoning for early prediction of mortality.

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“…The patients were treated and managed according to a single protocol that included calcium gluconate 10% (1 g for the initial dose, then 1 g every 6 hr, intravenously), magnesium sulphate (1 g initially, and then 1 g every 6 hr, intravenously), hydrocortisone (initially 200 mg and then 200 mg every 6 hr, intravenously), vitamin E (400 units, intramuscular injection), vitamin C (1000 mg every 12 hr, intravenous injection) and sodium bicarbonate (NaHCO 3 , intravenously) administration for treatment of acidosis. Other standard therapies included the administration of inotropic medications, intravenous fluids and electrolyte resuscitation, intubation and mechanical ventilation and, if indicated, anti‐arrhythmic agents .…”

Section: Methodsmentioning

confidence: 99%

Prognostic Factors in Acute Aluminium Phosphide Poisoning: A Risk‐Prediction Nomogram Approach

Farzaneh

Ghobadi

Akbarifard

et al. 2018

Basic Clin Pharma Tox

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Aluminium phosphide (AlP) is a toxic agent associated with a high mortality rate following acute exposure from various routes. The aim of this study was to determine the clinical and laboratory findings useful for predicting the medical outcome of AlP-poisoned patients using established scoring systems. This is a prospective study of AlP-poisoned patients from 2010 to 2015 in Ardabil, Iran. All patients that presented with a confirmed diagnosis of acute AlP poisoning in the study interval were included in the study. Clinical and laboratory data, using Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scoring systems, were compared for their predictive value in determining differences between survived and non-survived patients. Univariate analysis (Mann-Whitney or t-test), multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the Pearson correlation test were performed using STATA/SE 13.0 and the Nomolog Software. A total of 68 AlP-poisoned patients with confirmed acute AlP poisoning were included for evaluation. Of these, 36 were non-survived. Multiple logistic regression analysis was performed using parameters and values derived from patient clinical and laboratory data, and revealed that four factors were significant for predicting mortality: Glasgow coma score (GCS); systolic blood pressure (SBP); urinary output (UOP); and serum HCO . A four-variable, risk-prediction nomogram was developed for identifying high-risk patients and predicting the risk of mortality. Study results showed that SBP of <92.5 mmHg (p = 0.006); HCO < 12.9 mEq/L (p = 0.01), UOP < 1725 mL/day (p = 0.04); and GCS < 14.5 (p = 0.003) were significant predictors of AlP mortality. Scoring systems analysis showed SAPS II score >24.5, APACHE II score >8.5 and SOFA score >7.5 were predictive of non-survival patients. The results of our study showed that SBP, GCS, UOP and serum HCO levels are the best prognostic factors for predicting mortality in AlP-poisoned patients. According to the area under the ROC curve of the APACHE II score, when compared with SOFA and SAPS II scores, the APACHE II score can more effectively discriminate between non-survivors and survived patients.

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Acute aluminium phosphide poisoning, what is new?

Cited by 37 publications

References 24 publications

The Potential Role of S-100β Protein in Evaluation of CNS Affection and Prediction of Mortality in Acute Phosphides Intoxication

The Potential Role of S-100β Protein in Evaluation of CNS Affection and Prediction of Mortality in Acute Phosphides Intoxication

Clinical Data, Laboratory Investigations and Electrocardiographic Changes as Predictors of Mortality in Acute Aluminum Phosphide Poisoning

Prognostic Factors in Acute Aluminium Phosphide Poisoning: A Risk‐Prediction Nomogram Approach

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