Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: characteristics and predictive factors

Abstract

OBJECTIVESAluminum phosphide (ALP), also known in Iran as rice tablets, is one of the most effective rodenticides used to protect stored grain. However, ALP poisoning regularly causes mortality in humans. The aim of this study was to evaluate the characteristics and predictive factors of mortality from ALP poisoning.METHODSThis study evaluated all patients with ALP poisoning referred to Imam Khomeini Hospital in Kermanshah Province, Iran from 2014 to 2015. For each patient, the following information was recorded: age, sex, the number of tablets consumed, the number of suicide attempts, the time elapsed from consumption to treatment, blood pressure, blood pH, HCO3 levels, and PCO2 . Differences between the survivors and non-survivors of ALP poisoning were analyzed using univariate logistic regression and multivariate analysis.RESULTSIn this study, 48 patients were male and 29 patients were female (total: 77 patients). The average age of the survivors and non-survivors was 28.7 and 31.3 years, respectively. All cases (100%) of ALP poisoning were intentional, with the goal of committing suicide. The main predictive variables of mortality from ALP poisoning were blood pressure, blood pH, and time elapsed from consumption to treatment.CONCLUSIONSThe likelihood of mortality in patients with ALP poisoning can be predicted using blood pressure, blood pH, and time elapsed from consumption to treatment. These findings may help healthcare providers take more effective measures to treat patients with ALP poisoning.

Pattern and predictors of death from aluminum and zinc phosphide poisoning: A two years prospective study

“…Finally, the patients proceed to multi-organ failure and death within the first 24 to 48 hours after poisoning. Similar findings were also reported in many previous studies from different countries (Anger et al, 2000;Nocera et al, 2000;Navabi et al, 2018).…”

“PGI Score”: A Simplified Three-point Prognostic Score for Acute Aluminum Phosphide Poisoning

“… 10 One hundred percent CFR with blood pH <7.0 and 100% survival with pH >7.35 was observed by Shadnia et al 11 Navabi et al also demonstrated blood pressure, pH as well as the time interval between ingestion and treatment as significant predictors. 20 Low SBP, metabolic acidosis, and electrocardiographic abnormality were associated with poor outcome in a retrospective study from Egypt. 19 In another Egyptian study from a university hospital, Sheta et al studied the role of echocardiography for predicting the mortality which can detect low ejection fraction resulted from cardiac ischemia and decreased myocardial contractility in AlP poisoning.…”

“…Various studies have looked at numerous demographic, physiological, and biochemical parameters to access the severity of AlP poisoning; however, none of these factors, either alone or in combination, have been validated. 10 , 11 , 14 – 20 A simplified prognostic or severity scoring system, preferably clinical, is the need of the hour. In this study, we have looked at various predictors of CFR and sought to develop a precise and simple outcome prediction score for acute AlP poisoning.…”

Effect of aluminium phosphide (ALP) gas inhalation exposure on adipose tissue characteristics and histological toxicity in male rats

“…Aluminium phosphide (ALP), also known as rice tablet in Iran, is used throughout the world as a fumigant, rodenticide, pesticide, and insecticide for the control of insects and rodents through the fumigation of agricultural commodities, animal feeds, and processed foods [1,2]. In many developing countries, especially in Asia, ALP causes a high fatality rate (60-90%) [3,4]. A recent 8-year study showed an increased incidence of fatal ALP poisoning from 2006 to 2013 in Tehran, which included 2007 cases of phosphine poisoning-related deaths [5].…”

“…A recent 8-year study showed an increased incidence of fatal ALP poisoning from 2006 to 2013 in Tehran, which included 2007 cases of phosphine poisoning-related deaths [5]. The majority of ALP poisoning cases in Iran involve intentional acts of suicides although some accidental cases of ALP poisoning occur through the occupational exposure [3].…”