Predictive Factors of Mortality in Acute Aluminum Phosphide Poisoning: 5 Years Retrospective Study in Tanta Poison Control Unit

Abstract

Introduction: Aluminum phosphide (ALP) is a widely used rodenticide for grain preservation. Acute aluminum phosphide poisoning became one of the serious public health problems especially in developing countries due to its high mortality rates. Aim of the work: The aim of the present study was to evaluate the predictive factors of mortality from acute ALP poisoned cases admitted to Tanta Poison Control Unit in a 5 years interval from the start of January 2012 to the end of December 2016. Patients and methods: This retrospective study was performed on medical records of acute ALP poisoned patients admitted to Tanta Poison Control Unit during the 5 years period. Patients were divided according to their outcome into survivors and non-survivors. For all patients; sociodemographic data, toxicological data, physical examination, laboratory investigation and therapeutic intervention were recorded to evaluate their associations with the patients' outcome. Results: During the five years period, 105 acute ALP poisoned patients were admitted with 44.7% deaths. There was significant association between each of young age group, rural residence, suicidal ingestion, increase toxic dose and prehospitalization period with the risk of mortality. Other prognostic factors included altered consciousness, agitations, hypokalemia, hypernatremia, hyperglycemia, elevated (liver enzymes, blood urea& serum creatinine), need of mechanical ventilation, increased vasoactive drug administration and low magnesium sulphate administration were also associated with poor outcome. Moreover, presence of abnormal ECG, metabolic acidosis and low systolic blood pressure at admission were associated with high risk of mortality (odd ratios were 48.488, 10.251 and 0.964 respectively). Conclusion: Early recognition of the alarming risk factors with proper medical intervention may improve patients' outcome and decrease the mortality rate of acute aluminum phosphide poisoning. Recommendations: Owing to the increase mortality rates of ALP poisoning, it is recommended to make restrictions of its open sales and perform a safe manufacture forms in a not ingestible containers.

Development of a risk prediction nomogram for disposition of acute toxic exposure patients to intensive care unit

“…In this study, blood bicarbonate concentrations were another prognostic factor of ICU admission. In agreement with this finding, metabolic acidosis was a significant determining factor of poor outcomes in aluminium phosphide 55 and organophosphates 56 poisoned patients. Metabolic acidosis, unless quickly resolved, causes respiratory inhibition and cardiac arrest 57 …”

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

“…Furthermore, a significantly higher percentage of non-survivors showed abnormal blood pressure. These results were similar to results reported by El-Ebiary et al (2015) and El-Sarnagawy (2017). Aluminum phosphide induced hypotension is due to direct myocardial depressive effect, adrenal insufficiency with inadequate systemic vasoconstriction, massive intravascular fluid loss as a result of increased permeability of capillaries and decreasing left ventricular ejection fraction (Marashi et al, 2011;Farnaghi et al, 2013).…”

“…The ECG changes were significantly registered in non-survivors when compared to survivors. Parallel results were obtained by Shadnia et al (2009) and El-Sarnagawy (2017). Sinus tachycardia was the most common change among survivors and nonsurvivors while all other changes were more common among non-survivors than survivors.…”

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

“… 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. 16 However, echocardiography is not readily available in the majority of emergency rooms in LMIC.…”