Could N. Acetyl Cysteine Prolong Survival Time in Acute Aluminum Phosphide Poisoning Among Egyptian Patients?

Emam, Nermin; Shaaban, Sameera; Ahmed, Dalia

doi:10.21608/esctj.2020.40167.1000

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…The prevalence of ALP toxicity has been higher in the rural (81.7%), in compliance with the results of other recent studies [12]. However, there was no meaningful association between being rural and urban and the outcome of treatment.…”

Section: Discussion and Resultssupporting

confidence: 88%

The Treatment Results in Patients with Aluminum Phosphide Toxicity Admitted to Razi Hospital in Ahvaz

Jamshidi¹,

Tehrani²,

Ghorbani³

2021

PJMHS

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Introduction: Aluminum phosphide (ALP), locally known as "Rice Tablet", is a cheap and powerful pesticide used frequently to protect cereals. Cases of ALP toxicity have grown dramatically in recent decades by using it for suicide purposes. Treatment of ALP toxicity is largely supported by various remedies as there is no specific antidote. This study deals with the epidemiology of ALP toxicity in Khuzestan (Iran) and assesses the clinical and paraclinical manifestations, as well as the results of various treatments during the last 12 years. The study further examines the next suicidal intentions and subsequent complications of poisoning with ALP. Methodology: The records of all patients with ALP toxicity admitted to Razi Hospital in Ahvaz from 2006 to 2017 were reviewed within a retrospective study. Epidemiological and demographic information, clinical and paraclinical manifestations, and the results of various treatments were extracted. Data on the subsequent complications and the next suicidal intentions in those who have survived a suicide attempt were gathered and analyzed. Results: Of the 48 patients studied, 50% were male and the mean age was 29.33±10.45. Most of the toxicities were orally and with the intention of suicide in Ahvaz and Andimeshk. A total of 71.42% of the dead have been carried to this center. The majority of cases were reported from urban areas and in August and during summer. The most prevalent clinical signs were loss of consciousness, nausea, and vomiting. There were some differences in the experimental and EKG results. A meaningful correlation was observed between the administration and/or consumption of ranitidine, NAC, and intravenous sodium bicarbonate with treatment outcomes. Only one case of reattempt to suicide has been reported, and hematuria, ascites, and pleural effusion were widely visible in survivors. Conclusion: On-call counseling may decrease the rate of mortality in dispatching patients. Clinical and paraclinical manifestations can be useful in the diagnosis or prognosis. Patients' follow-up, actions to enhance public awareness, restrictions on the distribution of ALP, and availability of alternative substances can be helpful to diminish cases of ALP toxicity and/or death. Keywords: Aluminum phosphide (ALP), Rice tablets, Poisoning, Khuzestan

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Section: Discussion and Resultssupporting

confidence: 88%

The Treatment Results in Patients with Aluminum Phosphide Toxicity Admitted to Razi Hospital in Ahvaz

Jamshidi¹,

Tehrani²,

Ghorbani³

2021

PJMHS

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“…In terms of sociodemographic data, toxicological data, clinical characteristics, laboratory investigation results, and ECG findings, there were no significant changes between the saline and both the paraffin and coconut groups. These were comparable to previous research ( Farahani et al, 2016;Elgazzar et al, 2019;Darwish et al, 2020;Emam et al, 2020;Helal et al, 2022). These findings suggest that the sequentially numbered opaque sealed envelopes (SNOSE) approach was used to achieve optimal randomization in this research.…”

Section: Discussionsupporting

confidence: 90%

Comparison between Gastric Lavage with Paraffin Oil versus Coconut Oil in Acute Aluminum Phosphide Poisoning: A Randomized Controlled Clinical Trial

Elbastawesy

Elmansy

2023

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Background:The high mortality incidence of acute aluminum phosphide poisoning (ALP) poses serious problems for healthcare workers, especially in developing countries. There is no precise antidote, and the treatment is mainly supportive. As a result, novel therapeutic approaches must be evaluated to reduce the morbidity and mortality. Aim of the Study: Evaluation of the safety and efficacy of gastric lavage with paraffin oil versus coconut oil as adjuvants to sodium bicarbonate 8.4% solution for ALP poisoned patients. Methods: This double-blinded, parallel-group, randomized trial (Trial ID: NCT04724655) enrolled 60 symptomatic patients of both gender who presented within two hours of ALP exposure. The patients were randomly allocated into three equal groups (20 patients each). All groups received the conventional treatment. In paraffin group, patients were subjected to gastric lavage with a mixture of paraffin oil in addition to sodium bicarbonate 8.4%. In coconut group, patients were subjected to gastric lavage with a mixture of coconut oil and sodium bicarbonate 8.4%. In the saline group, patients were subjected to gastric lavage with a mixture isotonic saline added to sodium bicarbonate. Outcomes were recorded in all groups. Results: The percentage of deaths among patients who received paraffin and coconut oily substances for gastric lavage were nonsignificantly lower than patients in the saline group. In addition, there was a significant prolongation of hospital stays with higher survival time in both paraffin and coconut treated groups than in the saline group (p <0.001). Meanwhile, there was no significant difference between the paraffin and coconut groups. Furthermore, there were no reported significant adverse events of paraffin or coconut oil use. Conclusion: Paraffin oil and coconut oil might give hope to ALP poisoned patients; lowering the need for mechanical ventilation and significantly improve the survival time in patients who received oily gastric lavage solution than the saline-based solution with no adverse events.

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“…In this meta-analysis, all the included studies assessed the effect of IV NAC as an adjuvant therapy compared to supportive treatment alone [7][8][9][10]. The analysis revealed that IV NAC can reduce mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…2012). In(Bhalla et al 2017) there was no significant difference in its analysis[7,[9][10].Only three studies measured the need for mechanical ventilation(Tehrani, H. et al. 2013, Emam et al 2020 and El-Ebiary et al − 2017).…”

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confidence: 99%

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Efficacy of intravenous N acetylcysteine as an adjuvant therapy in the treatment of acute aluminum phosphide Poisoning: a systematic review and meta-analysis

Shaker,

Rageh,

Alnajar

et al. 2023

BMC Pharmacol Toxicol

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Background Aluminum phosphide toxicity is a serious problem in many countries. Unfortunately, there is no specific antidote. N-acetylcysteine has been used in some studies as adjuvant therapy depending on to its antioxidant properties. We hypothesized that IV N-acetylcysteine is effective in reducing mortality rate compared to supportive treatment alone. Methods We searched in PubMed, Scopus, Web of Science, and Cochrane Library databases. We only included randomized controlled trials that assessed the efficacy of IV N-acetylcysteine and supportive treatment versus supportive treatment alone in acute aluminum phosphide poisoning. Four investigators independently screened the studies’ results and designed the data extraction sheet. The primary and secondary outcomes were mortality and the need for mechanical ventilation rates. Random effects estimators with weights were used to result in the pooled risk ratios. Results We included four randomized controlled trials with 177 patients. 91 patients were distributed in N-acetylcysteine group and 86 patients in the control group. Mortality rates in N-acetylcysteine group and in the control group were 43.95% 66.27% respectively. There was a statistically significant reduction in mortality rate after leave out test (pooled risk ratio, 0.5; 95% confidence interval, 0.32–0.77). Regarding the need for mechanical ventilation, it was measured only in three RCTs. It was assessed in 67 patients in N-acetylcysteine group and 60 patients in the control group. 24 patients were ventilated in N-acetylcysteine group (35.8%) and 29 patients in the control group (48.3%). But it was statistically nonsignificant (pooled risk ratio, 0.71; 95% confidence interval, 0.48–1.04). Conclusion Our meta-analysis revealed that IV N-acetylcysteine may be effective in reducing mortality of severe aluminum phosphide poisoning cases. Trial registration Registration number in Prospero CRD42022375344 on 25 NOVEMBER 2022, retrospectively registered.

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Could N. Acetyl Cysteine Prolong Survival Time in Acute Aluminum Phosphide Poisoning Among Egyptian Patients?

Cited by 5 publications

References 27 publications

The Treatment Results in Patients with Aluminum Phosphide Toxicity Admitted to Razi Hospital in Ahvaz

The Treatment Results in Patients with Aluminum Phosphide Toxicity Admitted to Razi Hospital in Ahvaz

Comparison between Gastric Lavage with Paraffin Oil versus Coconut Oil in Acute Aluminum Phosphide Poisoning: A Randomized Controlled Clinical Trial

Efficacy of intravenous N acetylcysteine as an adjuvant therapy in the treatment of acute aluminum phosphide Poisoning: a systematic review and meta-analysis

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