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Bhardwaj T, Sharma S, Dalal J, Tanwar R. Effects of aluminium phosphide on larval morphometry of two important Chrysomya species. Int J Legal Med 2024; 138:73-83. [PMID: 36572803 DOI: 10.1007/s00414-022-02940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/07/2022] [Indexed: 12/28/2022]
Abstract
Chrysomya megacephala and C. rufifacies are globally predominant species of blowflies that are amongst the primary colonisers of decomposing carcasses. The development of blowflies has been studied extensively to estimate the minimum postmortem interval (PMImin). This article evaluates the effect of aluminium phosphide (AlP) on the larval morphometry and life cycles of C. megacephala and C. rufifacies. The rabbits were given different dosages of AlP and their livers were excised to rear C. megacephala and C. rufifacies. Through multiple-regression analysis, we assessed the overall impact of varying dosages of AlP on larvae of both species. AlP accelerated development until pupation, whilst the time until emergence remained the same. At higher concentrations, AlP had a positive effect on the development of these species. Since both species are abundant, forensic entomology studies examining the effect of AlP on morphometry and developmental stages would provide valuable information to investigators assessing PMImin.
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Affiliation(s)
- Tapeshwar Bhardwaj
- Department of Forensic Science, Maharshi Dayanand University, Rohtak, HR, 124001, India
| | - Sapna Sharma
- Department of Forensic Science, Maharshi Dayanand University, Rohtak, HR, 124001, India.
| | - Jyoti Dalal
- Department of Forensic Science, Lovely Professional University, Phagwara, PB, 144411, India
| | - Ravi Tanwar
- Department of Forensic Science, Maharshi Dayanand University, Rohtak, HR, 124001, India
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2
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Anbalagan LC, Arora N, Pannu AK. Management of Acute Aluminum Phosphide Poisoning: Has Anything Changed? Drug Metab Lett 2021; 14:106-116. [PMID: 34818996 DOI: 10.2174/1872312814666210813115625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022]
Abstract
Due to its easy availability, rapid and severe toxicity, and no specific antidote, aluminum phosphide has emerged as a lethal toxin, commonly used for suicidal intent in agricultural communities. Despite various advances in medicine, this compound's toxicity is poorly understood, and it still has a very high case fatality rate with no definitive treatment options available. This review aims to understand the mechanism of toxicity, clinical toxidrome of acute aluminum phosphide poisoning, and the available therapeutic options, including recent advances. A literature review was performed searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: ("aluminum phosphide poisoning" OR "aluminum phosphide poisoning toxicity" OR "aluminum phosphide ingestion") AND ("management" OR "therapy" OR "treatment"). Selected articles were discussed amongst all the authors to shape this review. High case fatality rate and lack of any specific antidote are persisting challenges. Therapeutic measures need to be implemented from all fronts - reducing easy access to the poison, developing less toxic alternatives for use as a pesticide, and more studies directed at developing an effective reversal agent for phosphine. The advent of promising agents like glucose-insulin-potassium infusion and lipid emulsion is a new ray of hope in the complete recovery in this fatal poisoning. The need of the hour is to find an agent that rapidly and effectively reverses aluminum phosphide's toxic effects. Large multicenter controlled trials are required to establish the role of glucose-insulin-potassium and lipid emulsion.
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Affiliation(s)
- Lokhesh C Anbalagan
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Navneet Arora
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashok K Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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3
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El Shehaby DM, Sayed SA, Abd El-Kareem DM, Elsherif R, Almaz D. Trimetazedine with hyperinsulinimea-euoglycemia, N-acetyl cysteine, and vitamin C: A new approach concept for management of aluminum phosphide poisoning. J Biochem Mol Toxicol 2021; 36:e22931. [PMID: 34665895 DOI: 10.1002/jbt.22931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/26/2021] [Accepted: 10/06/2021] [Indexed: 11/08/2022]
Abstract
Aluminum phosphide (AlP) is commonly used as a powerful suicidal tool. The exact mechanism of acute toxicity has not been well defined despite high mortality rates as well as its supportive treatment including rapid decontamination and institution of resuscitative measures. The current study aimed to investigate a new combination therapy using trimetazidine, N-acetyl cysteine, vitamin C, and hyperinsulinemia-euglycemia to manage acute AlP poisoning. Acute AlP-induced cardiotoxicity, hemodynamic changes, and hepatotoxicity were evaluated using electrocardiogram, creatinine kinase MB iso-enzyme, troponin-1, blood pressure, random blood glucose level, liver function tests, and histopathological changes in both the heart and liver in a rabbit model of AlP poisoning. The results showed that the new regimen therapy ameliorates the toxic effect of AlP with significant improvement in survival, cardiovascular and hemodynamic parameters in addition to histopathological changes. These results highlight the strong cardioprotective, antioxidant, hepatoprotective effects of the new combined therapy along with correction of hemodynamic changes and hyperglycemia as a potential target in the management of acute AlP poisoning.
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Affiliation(s)
- Doaa M El Shehaby
- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sally A Sayed
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Doaa M Abd El-Kareem
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Raghda Elsherif
- Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Doaa Almaz
- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Assiut University, Assiut, Egypt
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4
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Mohammadinejad A, Rizi KS, Oskuee RK, Aryan E, Meshkat Z, Ulianas A, Rezayi M. Development of detection methods for the diagnosis and analysis of highly toxic metal phosphides: A comprehensive and critical review. Biotechnol Appl Biochem 2021; 69:1121-1147. [PMID: 33987922 DOI: 10.1002/bab.2190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/03/2021] [Indexed: 01/29/2023]
Abstract
Metal phosphides, especially aluminum phosphide, and phosphine (PH3 ) are widely used as insecticides and rodenticides for protection of grains during process of storage and transportation. The main reason of poisoning with this compound is related to the conscious ingestion of salts or accidental inhalation of PH3 . So the early and accurate diagnosis of poisoning can significantly help to the effective clinical treatment or recognition of death cause. PH3 is somewhat unstable due to reaction with oxygen or hemoglobin leading to formation of oxy-acids phosphorous. Here, we critically reviewed the literature introducing the quantitative and qualitative methods for the detection of metal phosphides, PH3 , and its products. This study obviously demonstrates that during past years, different diagnosis methods have been remarkably progressed. Head-space gas chromatography and confirmatory colorimetric methods have been as the most popular techniques. Also, the gas sensors are a promising method that must be more progressed.
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Affiliation(s)
- Arash Mohammadinejad
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kobra Salimiyan Rizi
- Antimicrobial Resistance Research Center, Department of Medical Bacteriology and Virology, Qaem University Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Kazemi Oskuee
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Aryan
- Antimicrobial Resistance Research Center, Department of Medical Bacteriology and Virology, Qaem University Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Meshkat
- Antimicrobial Resistance Research Center, Department of Medical Bacteriology and Virology, Qaem University Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alizar Ulianas
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang. J1. Prof. Hamka, Air Tawar Padang, Indonesia
| | - Majid Rezayi
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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5
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Sabzi F, Heydari A, Moghaddam R, Rouzbahani M, Asadmobini A. A complex rare presentation of rice tablet poisoning: A case report. ACTA FACULTATIS MEDICAE NAISSENSIS 2021. [DOI: 10.5937/afmnai38-29018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aluminum phosphide, known as "rice tablet" (RT), is a common cause of suicide in adult women in Iran, with a high rate of lethal outcome. We report a patient with RT toxicity, with a complex syndrome of hepatic failure, renal failure, Brugada electrocardiography (ECG) patterns, and pleuropericardial effusion. The patient received conventional management with fluid therapy, gastric washing, activated charcoal followed by intra-aortic balloon pump insertion, inotropic drugs support, and mechanical ventilation. The unique features of our case are related to a combination of multiorgan failure with Brugada atypical ECG patterns and pleuropericardial effusion. Among the aforementioned complications, pleuropericardial effusion, ascites, and Brugada syndrome are exceedingly rare events. The patient was treated with high-dose inotropic drugs and intra-aortic balloon pump insertion. Despite tremendous management of metabolic acidosis, all efforts failed, and the patient died with sudden cardiac arrest.
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Abstract
Krokodil is the street name for a homemade mixture that has been used as a cheap substitute for heroin. The main active substance in krokodil is desomorphine, an opioid that is 10 times more potent than morphine. Krokodil use began in Russia and Ukraine but has spread throughout several countries in Europe and North America. Krokodil is produced from codeine tablets in a bootleg reaction performed under clandestine and unsanitary conditions. The toxicity of krokodil is characterized by devastating symptoms that start as black ulcers at the injection site and evolve to gangrene and limb amputation. The dangerous effects of krokodil are associated with its homemade nature and lack of purification prior to use. In this review, we discuss the chemical and pharmacological properties and the metabolism of desomorphine, the preparation of krokodil, and how its homemade nature contributes to its toxicity. The synthesis of krokodil produces several other morphinans in addition to desomorphine that warrant further study as possible analgesic alternatives to morphine.
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Affiliation(s)
- Emanuele Amorim Alves
- Department of Forensic Science, College of Humanities and Sciences, Virginia Commonwealth University 1015 Floyd Avenue, Richmond, Virginia 23284, United States
- Oswaldo Cruz Foundation, 21040-900 Rio de Janeiro-RJ, Brazil
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7
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Pathological changes induced by phosphine poisoning: a study on 8 children. Int J Legal Med 2019; 134:217-228. [PMID: 31713064 DOI: 10.1007/s00414-019-02169-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022]
Abstract
Aluminum phosphide (ALP) has been extensively used as an economical and effective insecticide, rodenticide, and fumigant. The active ingredient of ALP is phosphine (PH3), the use of which can lead to accidental inhalation and mass poisoning with high mortality. Exposure to PH3 will give rise to global damage in the human body. This study reviewed 4 fatal accidents including 8 children with PH3 poisoning and aimed to determine the pathological changes that resulted from exposure to PH3 and, secondly, aimed to determine whether oxidative stress was involved in PH3-induced neurotoxicity using histopathological and immunohistochemistry (IHC) methods. After focusing on the pathological changes on the major organs, we found severe damage induced by PH3 in many systems, especially the neurological system, including neuronal, axonal, and vascular injuries as well as oxidative damage with increased expression of 4-hydroxy-2-trans-nonenal (4HNE), 8-hydroxy-2'-deoxyguanosine (8-OH-dG), and 3-nitrotyrosine (3-NT) in the brain, which indicated that oxidative stress was a crucial mechanism for neuronal death in PH3 toxicity. Moreover, we observed severe myocardial and hepatocellular fatty degeneration in the tissues of the heart and liver. We considered that these characteristic changes are a suggestive sign of PH3 poisoning and partly explained the toxic mechanism of PH3 (inhibition of mitochondrial oxidative phosphorylation). We hope that this research could improve the understanding of the toxicity of PH3 in both forensic and clinical practice.
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Sheta AA, El-Banna AS, Elmeguid RA, Mohamed HE, Gad NH. A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:33135-33145. [PMID: 31520378 DOI: 10.1007/s11356-019-06457-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
Aluminum phosphide (AlP) is considered now one of the most common causes of poisoning among agricultural pesticides. Poisoning with AlP is extremely toxic to humans with high mortality rate. The aim of this work was to evaluate the prognostic factors and outcome of acute aluminum phosphide poisoning in Alexandria Main University Hospital during a period of 6 months from 1 November 2017 until the end of April 2018, highlighting the role of SOFA score and echocardiography in predicting the mortality. The prospective study was conducted on all patients admitted with acute AlP poisoning to Alexandria Main University Hospital for those 6 months. Patients' data were collected in a special sheet and included biosocial data, medical history, poisoning history, complete medical examination, investigations, duration of hospital stay, and the outcome. All patients were assessed according to SOFA score on admission. Thirty patients were admitted during the period of the current study. Females outnumbered males in all age groups with a sex ratio of 2.75:1. The mean age of patients was 22.77 ± 12.79 years. 96.6% of patients came from rural areas. 93.3% of the cases were exposed to poisoning at home, where suicidal poisoning accounted for (86.7%) of cases. 43.3% of patients died (n = 13), and the median value of SOFA score among non-survivors was 10, versus 1 among survivors. The median value of ejection fraction among non-survivors (25%) was half its value in survivors (50%). Although there were many predictors of severity of AlP poisoning, SOFA score was the most predictive factor of mortality detected by multivariate analysis.
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Affiliation(s)
- Abeer A Sheta
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Asmaa S El-Banna
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Rania Abd Elmeguid
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany E Mohamed
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nehad H Gad
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Yan H, Chen H, Li Z, Shen M, Zhuo X, Wu H, Xiang P. Phosphine Analysis in Postmortem Specimens Following Inhalation of Phosphine: Fatal Aluminum Phosphide Poisoning in Children. J Anal Toxicol 2018; 42:330-336. [PMID: 29378027 DOI: 10.1093/jat/bky005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Indexed: 11/13/2022] Open
Abstract
Phosphine is an insecticide for the fumigation of grains, animal feed, and leaf-stored tobacco, and it was used as a rodenticide in bulk grain stores. Phosphine poisoning may occur after accidental inhalation of phosphine, sometimes leading to death. Analysis of phosphine and its metabolites in postmortem specimens from seven fatal cases was conducted in this study, as well as postmortem specimens collected from rabbits exposed to phosphine. The total phosphine in postmortem specimens was analyzed by headspace gas chromatography coupled with mass spectrometry. Diagnosis of aluminum phosphide poisoning was made after postmortem toxicological analysis and confirmed by police investigation. The deaths of the children occurred after inhalation of phosphine generated from aluminum phosphide contacting moisture in the air in all seven fatal cases. The concentration of total phosphine in the biological fluids and tissues of victims ranged from 0.2 to 4.7 μg/mL (μg/g). Animal experiments demonstrated that the phosphine generated from aluminum phosphide could rapidly cause death. The toxicological analysis of postmortem specimens provides useful information in diagnosis of aluminum phosphide poisoning in forensic science. As an important fumigation pesticide, aluminum phosphide deserves special attention, especially since there is no specific antidote and there is a high fatality rate.
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Affiliation(s)
- Hui Yan
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Hang Chen
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Zhengdong Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Min Shen
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Xianyi Zhuo
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Hejian Wu
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Ping Xiang
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
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Changal KH, Latief M, Parry M, Abbas F. Aluminium phosphide poisoning with severe cardiac dysfunction and the role of digoxin. BMJ Case Rep 2017; 2017:bcr-2017-220125. [PMID: 28801325 PMCID: PMC5614089 DOI: 10.1136/bcr-2017-220125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/04/2022] Open
Abstract
Aluminium phosphide (ALP) is a common cause of suicidal poisoning in India where it is easily available and commonly known as 'rice tablet'. In rural areas of India, it is still used to protect rice and stored grains from rodents and pests. 1 There is no specific antidote for phosphide poisoning and treatment involves meticulous supportive care. Ingestion can lead to severe cardiac suppression and cardiogenic shock. For patients poisoned with ALP who continue to have refractory shock with persistent myocardial suppression despite the use of adrenergic inotropic agents, the addition of digoxin may be beneficial. We present a case where digoxin was utilised with beneficial patient outcomes.
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Affiliation(s)
- Khalid Hamid Changal
- Department of Internal Medicine, Mercy St. Vincent's Medical Center, Toledo, Ohio, USA
| | - Muzamil Latief
- Department of Internal Medicine, Maharishi Markandeshwar University, Mullana, India
| | - Manzoor Parry
- Department of Internal Medicine, Maharishi Markandeshwar University, Mullana, India
| | - Farhat Abbas
- Department of Internal Medicine, Government Medical College Srinagar, Srinagar, India
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Diagnosis of aluminum phosphide poisoning using a new analytical approach: forensic application to a lethal intoxication. Int J Legal Med 2017; 131:1001-1007. [DOI: 10.1007/s00414-017-1562-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
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Mashayekhian M, Hassanian-Moghaddam H, Rahimi M, Zamani N, Aghabiklooei A, Shadnia S. Elevated Carboxyhaemoglobin Concentrations by Pulse CO-Oximetry is Associated with Severe Aluminium Phosphide Poisoning. Basic Clin Pharmacol Toxicol 2016; 119:322-9. [DOI: 10.1111/bcpt.12571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammad Mashayekhian
- Toxicological Research Center; Department of Clinical Toxicology; Loghman-Hakim Hospital; School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Hossein Hassanian-Moghaddam
- Toxicological Research Center; Department of Clinical Toxicology; Loghman-Hakim Hospital; School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
- Excellence Center of Clinical Toxicology; Iranian Ministry of Health; Tehran Iran
| | - Mitra Rahimi
- Toxicological Research Center; Department of Clinical Toxicology; Loghman-Hakim Hospital; School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
- Excellence Center of Clinical Toxicology; Iranian Ministry of Health; Tehran Iran
| | - Nasim Zamani
- Toxicological Research Center; Department of Clinical Toxicology; Loghman-Hakim Hospital; School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
- Excellence Center of Clinical Toxicology; Iranian Ministry of Health; Tehran Iran
| | - Abbas Aghabiklooei
- Toxicological Research Center; Department of Clinical Toxicology; Loghman-Hakim Hospital; School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
- Department of Forensic Medicine; Iran University of Medical Sciences; Tehran Iran
| | - Shahin Shadnia
- Toxicological Research Center; Department of Clinical Toxicology; Loghman-Hakim Hospital; School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
- Excellence Center of Clinical Toxicology; Iranian Ministry of Health; Tehran Iran
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Abstract
Metal phosphides such as aluminum phosphide are potent insecticides. This highly toxic substance is used for rice and other grains protection in Iran. Due to its high toxicity potential and easy availability, it is widely used as a suicide poison. This substance has no effective antidote and the incidence of deaths due to its poisoning is increasing day by day in Iran. The present study was conducted to show the increasing incidence of fatal aluminum phosphide poisoning and its toxicological and forensic aspects in an 8-year study, 2006 to 2013. Autopsy sheets were reviewed and cases with the history of aluminum phosphide poisoning were selected. Toxicological analysis results, demographic and necroscopic examination findings were studied. A total of 51.8% of studied cases were female. Most of the cases were between 10 and 40 years old. The manner of death was self-poisoning in 85% of cases. Morphine, ethanol, and amitriptyline were the most common additional drugs detected in toxicological analysis. The incidence of fatal aluminum phosphide poisoning cases referred for phosphine analysis was 5.22 and 37.02 per million of population of Tehran in 2006 and 2013, respectively. The results of this study showed that in spite of ban and restrictions, there was a dramatic increase in the incidence of fatal aluminum phosphide poisoning in Tehran from 2006 to 2013. Safety alert should be highlighted in training program for all population groups about the toxic effects of aluminum phosphide tablets.
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Affiliation(s)
- Afshar Etemadi-Aleagha
- From the Tehran University of Medical Sciences (TUMS), Amir Alam Hospital, Tehran, Iran (AE-A) and Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran (MA, FSI)
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Loddé B, Lucas D, Letort JM, Jegaden D, Pougnet R, Dewitte JD. Acute phosphine poisoning on board a bulk carrier: analysis of factors leading to a fatal case. J Occup Med Toxicol 2015; 10:10. [PMID: 25763098 PMCID: PMC4354992 DOI: 10.1186/s12995-015-0050-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/18/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To determine accidental factors, clinical presentation and medical care in cases of seafarers presenting phosphine poisoning symptoms on board a bulk carrier. To consider primary prevention of this pathology, which can have extremely severe consequences. METHODS To analyse circumstances resulting in toxic exposure to phosphine in the sea transport sector. To obtain information from medical reports regarding the seafarer's rescue. To identify the causes of this accidental poisoning and how to establish an early, appropriate diagnosis thus avoiding other cases. RESULTS In February 2008, on board a bulk carrier with a cargo of peas, a 56-year-old seafarer with intense abdominal and chest pains, associated with dizziness, was rescued by helicopter 80 miles away from the coast. Despite being admitted rapidly to hospital, his heart rate decreased associated with respiratory distress. He lost consciousness and convulsed. He finally died of pulmonary oedema, major metabolic acidosis and acute multi organ failure. The following day, the captain issued a rescue call from the same vessel for a 41-year-old man also with abdominal pain, vomiting and dizziness. The ECG only revealed type 1 Brugada syndrome. Then 11 other seafarers were evacuated for observation. 3 showed clinical abnormalities. Collective poisoning was suspected. Medical team found out that aluminium phosphide pellets had been put in the ship's hold for pest control before the vessel's departure. Seafarers were poisoned by phosphine gas spreading through cabins above the hold. It was found that the compartments and ducts were not airtight. CONCLUSION Unfortunately, a seafarer on board a bulk carrier died in 2008 because of acute phosphine poisoning. Fumigation performed using this gas needs to be done with extreme care. Systematic checks need to be carried out before sailing to ensure that the vessel's compartments are airtight.
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Affiliation(s)
- Brice Loddé
- European University of Brest, EA 4686 - CS 93837 - 29238, Brest, Cedex 3 France ; Occupational and Environmental Diseases Department (Service de Santé au Travail et Maladies liées à l'environnement) CHRU Morvan, 2 avenue FOCH, 29609 Brest, Cedex France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France
| | - David Lucas
- Occupational Health Service in Iroise (Service de santé au travail en Iroise), 37, rue Voltaire, 29200 Brest, France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France ; European Society for Environmental and Occupational Medicine, Hamburg, Deutschland
| | - Jean-Marie Letort
- Emergency Department and Maritime Emergencies (Service d'urgences et SAMU de coordination médicale maritime), CHRU La Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France
| | - Dominique Jegaden
- Occupational Health Service in Iroise (Service de santé au travail en Iroise), 37, rue Voltaire, 29200 Brest, France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France
| | - Richard Pougnet
- European University of Brest, EA 4686 - CS 93837 - 29238, Brest, Cedex 3 France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France
| | - Jean-Dominique Dewitte
- European University of Brest, EA 4686 - CS 93837 - 29238, Brest, Cedex 3 France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France
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Hussain K, Abubaker J, Ahmad Dar J, Ahmed R. Acute peripheral polyneuropathy with multiorgan failure: a diagnostic dilemma. CASE REPORTS 2014; 2014:bcr-2014-203989. [DOI: 10.1136/bcr-2014-203989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moghadamnia AA. An update on toxicology of aluminum phosphide. ACTA ACUST UNITED AC 2012; 20:25. [PMID: 23351193 PMCID: PMC3555759 DOI: 10.1186/2008-2231-20-25] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 05/17/2012] [Indexed: 01/11/2023]
Abstract
Aluminum phosphide (AlP) is a cheap solid fumigant and a highly toxic pesticide which is commonly used for grain preservation. In Iran it is known as the “rice tablet”. AlP has currently aroused interest with increasing number of cases in the past four decades due to increased use in agricultural and non-agricultural purposesand also its easy availability in the markets has increased its misuse to commit suicide. Upon contact with moisture in the environment, AlP undergoes a chemical reaction yielding phosphine gas, which is the active pesticidal component. Phosphine inhibits cellular oxygen utilization and can induce lipid peroxidation. It was reported that AlP has a mortality rate more than 50% of intoxication cases. Poisoning with AlP has usually occurred in attempts to suicide. It is a more common case in adults rather than teen agers. In some eastern countries it is a very common agent with rapid action for suicide. Up to date, there is no effective antidote or treatment for its intoxication. Also, some experimental results suggest that magnesium sulfate, N-acetyl cysteine (NAC), glutathione, vitamin C and E, beta-carotenes, coconut oil and melatonin may play an important role in reducing the oxidative outcomes of phosphine. This article reviews the experimental and clinical features of AlP intoxication and tries to suggest a way to encounter its poisoning.
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Phosphide poisoning: A review of literature. Forensic Sci Int 2012; 214:1-6. [DOI: 10.1016/j.forsciint.2011.06.018] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/18/2011] [Accepted: 06/19/2011] [Indexed: 11/18/2022]
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Gurjar M, Baronia AK, Azim A, Sharma K. Managing aluminum phosphide poisonings. J Emerg Trauma Shock 2011; 4:378-84. [PMID: 21887030 PMCID: PMC3162709 DOI: 10.4103/0974-2700.83868] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 09/02/2010] [Indexed: 11/04/2022] Open
Abstract
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 KMnO(4), 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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Affiliation(s)
- Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
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El Naggar ARM, El Mahdy NM. Zinc phosphide toxicity with a trial of tranexamic acid in its management. J Adv Res 2011. [DOI: 10.1016/j.jare.2011.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gras R, Luong J, Hawryluk M, Monagle M. Analysis of part-per-billion level of arsine and phosphine in light hydrocarbons by capillary flow technology and dielectric barrier discharge detector. J Chromatogr A 2010; 1217:348-52. [DOI: 10.1016/j.chroma.2009.11.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 11/05/2009] [Accepted: 11/16/2009] [Indexed: 11/28/2022]
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Yu Q, Tang X, Yi H, Ning P, Yang L, Yang L, Yu L, Li H. Equilibrium and heat of adsorption of phosphine on CaCl2-modified molecular sieve. ASIA-PAC J CHEM ENG 2009. [DOI: 10.1002/apj.301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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