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Hafez ASAF, Elgazzar FM, Sobh ZK, El-Ebiary AA. Gastrointestinal decontamination using oil-based solutions in patients with acute aluminum phosphide poisoning: a systematic review and meta-analysis. Crit Rev Toxicol 2024; 54:235-251. [PMID: 38656260 DOI: 10.1080/10408444.2024.2329624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
Some studies suggested that gastrointestinal (GIT) decontamination with oil may improve the prognosis of patients who ingested aluminum phosphide (AlP). The aim of this study is to compare the efficacy and safety of gastric lavage with oil-based solutions to any method of gastric decontamination not using oils in patients presenting with acute AlP poisoning. The literature was searched for English-published randomized controlled trials (RCTs) from inception to 16 September 2023. The searched electronic databases included MEDLINE/PubMed, Cochrane Library, Web of Science, Egyptian Knowledge Bank, Scopus, and Google Scholar. Data were extracted and pooled by calculating the risk ratio (RR) for categorical outcomes and standardized mean difference (SMD) for numerical outcomes, with 95% confidence intervals (CI). Seven RCTs were included. Paraffin oil was significantly associated with a lower risk of mortality (RR = 0.59 [95% CI: 0.45, 0.76], p < .001), intubation (RR = 0.59 [95% CI: 0.46, 0.76], p < .001) and vasopressor need (RR = 0.71 [95% CI: 0.56, 0.91], p = .006). Survival time was significantly prolonged with paraffin oil (SMD = 0.72 [95% CI: 0.32, 1.13], p < .001). Coconut oil was significantly associated with prolonged survival time (SMD = 0.83 [95% CI: 0.06, 1.59], p = .03) as well as decreased risk of requiring intubation (RR = 0.78 [95% CI: 0.62, 0.99], p = .04). Oil-based GIT decontamination using paraffin oil showed benefits over conventional lavage regarding the incidence of in-hospital mortality and endotracheal intubation, and survival time. Coconut oil showed some benefits in terms of the intubation incidence and survival time. Decontamination using paraffin oil is recommended. Future clinical trials are warranted with larger sample sizes and focusing on cost-benefit and safety.
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Affiliation(s)
- Amal S A F Hafez
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Fatma M Elgazzar
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Zahraa K Sobh
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmad A El-Ebiary
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
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De Santi O, Orellana MJ, Di Niro CA, Lashin HI, Greco V. The adjuvant effect of oil-based gastric lavage on the outcome of acute Aluminum phosphide poisoning: a systematic review and meta-analysis. Toxicol Res (Camb) 2024; 13:tfae029. [PMID: 38496382 PMCID: PMC10939350 DOI: 10.1093/toxres/tfae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/04/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Aluminum Phosphide (AlP) poisoning constituted the most common cause of poisoning death in some low- and middle-income countries (LMICs). This study aimed to evaluate the safety and efficacy of oil-based gastric lavage (GL) compared with standard therapy for the treatment of AlP poisoning. Materials and methods. This systematic review complied with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) Protocols. A comprehensive search was carried out, identifying randomized controlled trials (RCTs), including anyone presenting within 6 h of exposure to AlP, and the administration of GL with oils, including liquid paraffin or coconut oil. Results We identified 7 RCTs. The evidence from 4 RCTs indicates that GL with paraffin oil is an effective treatment for acute AlP poisoning, decreasing the mortality rate (RR = 0.62; 95% CI = 0.48 to 0.81; participants = 226; I 2 = 10%; low-quality evidence). We estimate the Number Needed to Treat of 4. Likewise, this intervention reduces the need for intubation and mechanical ventilation (RR = 0.62; 95% CI = 0.40 to 0.79; I2 = 0%; low-quality evidence). Regarding GL with coconut oil, the evidence from 4 RCTs, indicates a slight reduction in mortality (RR = 0.82; 95% CI = 0.69 to 0.98; participants = 112; I2 = 0%; very low-quality evidence). Conclusions Limited evidence suggests that GL with paraffin oil is effective in reducing the mortality rate. Likewise, limited evidence showed in favor of paraffin oil concerning the need for intubation and mechanical ventilation. Very limited evidence suggests that GL with coconut oil could reduce mortality. Both interventions would have a benign safety profile.
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Affiliation(s)
- Omar De Santi
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones (CNI), Buenos Aires, Arturo U. Illia Av. (w/o number) and Marconi Morón 386, B1684, El Palomar, Buenos Aires, Argentina
| | - Marcelo J Orellana
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones (CNI), Buenos Aires, Arturo U. Illia Av. (w/o number) and Marconi Morón 386, B1684, El Palomar, Buenos Aires, Argentina
| | - Cecilia A Di Niro
- Cardiology, Hospital Municipal Central de San Isidro “Melchor A. Posse”, Buenos Aires, Argentina. Av. Sta Fe 431, B1641 Acassuso, Provincia de Buenos Aires, Argentina
| | - Heba I Lashin
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University Toxicologist. Tanta University, Poison Control Center (TUPCC), Tanta, Gharbia 31111, 31527, Egypt
| | - Vanina Greco
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones (CNI), Buenos Aires, Arturo U. Illia Av. (w/o number) and Marconi Morón 386, B1684, El Palomar, Buenos Aires, Argentina
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Sobh ZK, Ghanem M, Kholief M. Physicians' perspectives on different therapeutic approaches for aluminum phosphide poisoning and their relevant outcomes. Toxicol Res (Camb) 2023; 12:615-625. [PMID: 37663810 PMCID: PMC10470372 DOI: 10.1093/toxres/tfad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 09/05/2023] Open
Abstract
Background Aluminum phosphide is a highly toxic pesticide that results in high mortality. To date, there is neither a definitive antidote nor a unified protocol for managing acute aluminum phosphide poisoning. Objectives This cross-sectional questionnaire-based study aims to explore different management approaches and rely on the expertise of Egyptian medical professionals to enhance the prognosis for acute aluminum phosphide poisoning. Subjects and methods A self-administered questionnaire was formulated and electronically distributed according to published literature and experience of senior physicians. Results and conclusions Responses were received from 151 physicians from 10 governorates. Management modalities were variable among respondents. Noradrenaline was used by 90.7% of respondents with no fixed-dose regimen. In all, 84.1% of participants utilized oil in gastrointestinal decontamination; paraffin oil was the most used solution. Overall, 92.1, 61.6, 46.4, and 34.4% of participants used sodium bicarbonate, proton pump inhibitors, IV magnesium sulfate, and antioxidants, respectively. Regarding the frequency of acute aluminum phosphide poisoning, 47% of participants managed these cases daily or a few times a week. Participants' responses denoted a poor prognosis of acute aluminum phosphide poisoning, and high percentages attributed the prognosis to exposure factors rather than treatment modalities. Statistical analysis revealed that using oil in gastrointestinal decontamination improved the outcome by 4.62-fold. Clinical toxicologists were more likely to rescue ≥ 30% of the cases about 3-fold (2.97) than other specialties. Clinical toxicologists used oil in gastrointestinal decontamination, magnesium sulfate, and antioxidant therapy and calculated base deficit before administration of sodium bicarbonate by 7.70-, 5.30-, 3.26-, and 2.08-fold than other specialties.
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Affiliation(s)
- Zahraa K Sobh
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
| | - Maha Ghanem
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
| | - Marwa Kholief
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
- Center of Excellence for Research in Regenerative Medicine and Applications (CERRMA) in Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
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Sobh ZK, Abd-Elhameed A. The therapeutic benefit of antioxidants on the outcome of acute aluminum phosphide poisoning: a systemic review and meta-analysis. Toxicol Res (Camb) 2023; 12:345-354. [PMID: 37397917 PMCID: PMC10311134 DOI: 10.1093/toxres/tfad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 07/04/2023] Open
Abstract
This systematic review and meta-analysis pool evidence available from clinical trials to verify the effect of antioxidants on the outcome of acute aluminum phosphide (AlP) poisoning. A systematic review complied with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) Protocols. Meta-analysis was conducted on 10 studies that fulfill eligibility criteria. Four antioxidants were implemented: N-Acetyl cysteine (NAC), L-Carnitine, Vitamin E, and Co-enzyme Q10 (Co Q10). Risk of bias, publication bias, and heterogeneity were assessed to ensure the results' reliability. Antioxidants significantly decrease mortality of acute AlP poisoning around three folds (OR = 2.684, 95% CI: 1.764-4.083; P < .001) and decrease the need for intubation and mechanical ventilation by two folds (OR = 2.391, 95% CI 1.480-3.863; P < .001) compared with control. Subgroup analysis revealed that NAC significantly decreases mortality by nearly three folds (OR = 2.752, 95% CI: 1.580-4.792; P < .001), and vitamin E significantly decreases mortality by nearly six folds (OR = 5.667, 95% CI: 1.178-27.254; P = .03) compared with control. L-Carnitine showed a borderline significance (P = .050). Co Q10 decreased the mortality compared with the control; however, the difference was not statistically significant (P = .263). This meta-analysis provides solid evidence regarding the efficacy of antioxidants in improving the outcome of acute AlP poisoning with reference to NAC. Wide confidence interval and small relative weight affect reliability regarding vitamin E efficacy. Future clinical trials and meta-analyses are recommended. To our knowledge, no previous meta-analysis was conducted to investigate the efficacy of treatment modalities for acute AlP poisoning.
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Affiliation(s)
- Zahraa K Sobh
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University Alexandria, 21517, Egypt
| | - Asmaa Abd-Elhameed
- Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria 21524, Egypt
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Elsharkawy RE, Ghonem MM, El-Sarnagawy GN, Nagy AA, Heshmat MM. Cardioprotective role of the coenzyme Q10 and coconut oil in acute aluminum phosphide poisoning: a randomized controlled clinical trial. Toxicol Res (Camb) 2023; 12:507-519. [PMID: 37397927 PMCID: PMC10311162 DOI: 10.1093/toxres/tfad037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 07/04/2023] Open
Abstract
Aluminum phosphide (ALP)-induced cardiotoxicity is a major cause of high mortality rates. As there is no specific antidote, restoring cardiac hemodynamics is the cornerstone for saving patients. Based on oxidative stress theory in acute ALP poisoning, we examined the cardioprotective role of coconut oil and Coenzyme Q10 (COQ10) in ALP poisoning, focusing on their antioxidant capacity. This study was a randomized, controlled, single-blind, phase II clinical trial conducted at Tanta Poison Control Center over 1 year. Eighty-four ALP poisoned patients received supportive treatment and were randomly allocated to three equal groups. Gastric lavage was performed using sodium bicarbonate 8.4% with saline in group I. Alternatively, group II received 50 ml coconut oil, and group III initially received 600 mg CoQ10 dissolved in 50 ml coconut oil; and repeated 12 hours later. In addition to patient characteristics, clinical, laboratory, electrocardiography (ECG), and total antioxidant capacity (TAC) data were recorded and repeated 12 hours later. Patient outcomes were evaluated. There was no significant difference among groups considering patient characteristics, initial cardiotoxicity severity, vital, laboratory data, ECG changes, and TAC. However, 12 hours post-admissions, group III was significantly improved in all clinical, laboratory, and ECG parameters than comparable groups. Significant correlations were observed between elevated TAC in groups II and III with hemodynamic, serum troponin, and ECG variables. Accordingly, the need for intubation, mechanical ventilation, and the total vasopressor dose was significantly decreased in group III compared with other groups. Therefore, coconut oil and COQ10 are promising cardioprotective adjuvant therapy ameliorating the ALP-induced cardiotoxicity.
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Affiliation(s)
- Rasha E Elsharkawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Mona M Ghonem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Ayman A Nagy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Mona M Heshmat
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
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Abdelhamid WG, Sakr ML, Mostafa OE, Zaafar D, Abdelwahab HM. Comparing the effectiveness of L-carnitine and paraffin oil in acute aluminum phosphide poisoning using predictive biomarkers and scores: A randomized controlled clinical trial. Hum Exp Toxicol 2023; 42:9603271221149650. [PMID: 36592154 DOI: 10.1177/09603271221149650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aluminum phosphide (AlP) poisoning is a serious medical emergency with a high mortality rate. The absence of an exact antidote for AlP poisoning necessitates the quest for alternative treatment options. The study sought to assess the efficacy of adding L-carnitine or medicated paraffin oil to the conventional approach of treatment employed in cases of acute AlP poisoning. We conducted a 1 year, randomized, controlled, parallel-group, single-blind clinical study. 96 individuals with acute AlP poisoning were randomly assigned to one of three groups. The standard AlP therapy was administered to all groups according to the Poison Control Center guidelines at the Ain-Shams University hospitals. All patients underwent a medical history review, clinical examination, and laboratory tests. The outcomes were assessed. The participants in the study groups had mean ages ranging from 25.6 to 26.3 years. The cases analyzed were evenly distributed between genders, with the majority originating from rural areas. The average delay time varied from 2.9 to 4.2 h. All patients in the study reported ingesting AlP during suicide attempts. 12 hours after admission, many clinical and biochemical data improved in both intervention groups including cytochrome c oxidase, caspase-3, caspase-9, catalase, and superoxide dismutase. The intervention groups required significantly less mechanical ventilation and had a lower mortality rate than the control group. Decontamination with paraffin oil could be advantageous for reducing the severity of AlP poisoning, improving prognosis, and lowering the mortality rate.
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Affiliation(s)
- Walaa G Abdelhamid
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, 68792Ain Shams University, Egypt
| | - Mahmoud L Sakr
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, 68792Ain Shams University, Egypt
| | - Olfat E Mostafa
- Biochemistry Department, Poison Control Center, 68792Ain Shams University Hospitals, Egypt
| | - Dalia Zaafar
- Pharmacology and Toxicology Department, Faculty of Pharmacy, 609869Modern University for Technology and Information, Egypt
| | - Hanan M Abdelwahab
- Clinical Toxicology Department, Poison Control Center, 110120Ain Shams University Hospitals, Egypt
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Helal NE, Lashin HI, Nagy AA, Shama MA, Mostafa TAH, Wahdan AA. Potential role of paraffin oil gastric lavage in acute aluminum phosphide poisoning: a randomized controlled trial. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:33844-33855. [PMID: 35031985 DOI: 10.1007/s11356-021-17778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
Aluminum phosphide (ALP) poisoning is a true medical emergency associated with high mortality. The lack of a specific antidote for ALP poisoning mandates searching for new treatment modalities. This study aimed to evaluate the effectiveness and safety of gastric decontamination by paraffin oil in cases with acute ALP poisoning. This study was a randomized, controlled, parallel-group, single-blind, phase II clinical trial conducted over a period of 6 months. Sixty-two patients with acute ALP poisoning were randomly allocated into two equivalent groups. In both groups, the standard ALP treatment was given. Gastric decontamination in the control group was performed by saline and sodium bicarbonate 8.4%, while in the intervention group, it was done by paraffin oil and sodium bicarbonate 8.4%. All patients were subjected to history taking, clinical examination, and laboratory investigations. The outcomes were evaluated. The median age of the studied patients was 20 years. Most of the studied cases were females, single, and from rural areas. The median delay time was 1 h. All patients included in the study alleged ingestion of ALP during suicidal attempts. Twelve hours after admission, many clinical and laboratory findings were significantly better in the intervention group. The need for intubation, mechanical ventilation, and total amount of vasopressors was significantly lower, and the mortality rate was non-significantly lower in the intervention group compared to the control. The median length of hospital stay was significantly shorter in the control group. Gastric decontamination with paraffin oil and sodium bicarbonate 8.4% could be valuable in reducing ALP poisoning severity, the need for intubation, mechanical ventilation, and vasopressors.
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Affiliation(s)
- Nadia E Helal
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt
| | - Heba I Lashin
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt
| | - Ayman A Nagy
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt
| | - Mohamed A Shama
- Department of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tarek Abdel Hay Mostafa
- Department of Anaesthesiology and Critical Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amira A Wahdan
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt.
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Naddafi M, Mehrizi AA, Eghbal MA, Khansari MG, Azarmi Y, Sattari MR, Karaman C, Karimi F, Alizadeh M, Yazdani MN, Hosseinpour P. Reducing the risk of death induced by aluminum phosphide poisoning: The new therapies. CHEMOSPHERE 2022; 294:133800. [PMID: 35101429 DOI: 10.1016/j.chemosphere.2022.133800] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Numerous people suffer from accidental or deliberate exposure to different pesticides when poisoning with aluminum phosphate (AlP) is increasing in the eastern countries. Aluminum phosphate is a conventional insecticide that quickly reacts with water or the moistures in the atmosphere and produces fatal phosphine gas, which absorbs quickly by the body. Oral consumption or inhalation of AlP leads to excessive reaction of the body such as fatigue, vomiting, fever, palpitation, vasodilatory shock, increasing blood pressure, cardiac dysfunction, pulmonary congestion, shortness of breath, and death. The garlic smell from the patient's mouth or exhale is one of the methods to recognize the positioning. Due to the lack of individual antidotes, several supportive treatments are required. The present study focused on the available and new therapies that help reduce the effect of AlP poisoning and the mortality rate. The therapies are divided into the antioxidant-related agent and the other agents. The impacts of each agent on the experimental cases are reported.
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Affiliation(s)
- Mastoureh Naddafi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbasali Abouei Mehrizi
- School of Physics, University of Electronic Science and Technology of China, Chengdu, 610054, China.
| | - Mohammad Ali Eghbal
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Ghazi Khansari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yadollah Azarmi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Sattari
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ceren Karaman
- Akdeniz University, Department of Electricity and Energy, Antalya, 07070, Turkey.
| | - Fatemeh Karimi
- Department of Chemical Engineering, Quchan University of Technology, Quchan, 9477177870, Iran
| | - Marzieh Alizadeh
- Pharmeceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Laboratory of Basic Sciences, Mohammad Rasul Allah Research Tower, Shiraz University of Medical Sciences, Shiraz, PO Box: 71348-14336, Iran
| | - Mohammad Nima Yazdani
- Laboratory of Basic Sciences, Mohammad Rasul Allah Research Tower, Shiraz University of Medical Sciences, Shiraz, PO Box: 71348-14336, Iran
| | - Parsa Hosseinpour
- Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran
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Mashali AA, Salama NH, Elsobky HA, Sobh ZK. Prediction of zinc phosphide-induced hepatotoxicity and cardiotoxicity from clinical, laboratory, and radiological indicators. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:39547-39559. [PMID: 32651786 DOI: 10.1007/s11356-020-10020-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
Zinc phosphide (Zn3P2) is a phosphine-generating pesticide. Serious hepatotoxicity or cardiotoxicity might develop late in initially stable patients. The current prospective study aimed to predict Zn3P2-induced hepatotoxicity and cardiotoxicity. This prospective cross-sectional study included 150 patients admitted to the Alexandria Poison Center (APC) for over 6 months (from August 2018 to January 2019). The recorded patients' data included personal data, poisoning, medical history, clinical assessment using the poisoning severity score (PSS), investigations, and the outcome. The mean age of the patients was 23.36 ± 13.53 years. Females constituted 68.7%, and 76% of the patients ingested Zn3P2 deliberately. Only two cases that ingested the highest amount of Zn3P2 had radio-opaque shadows in the abdominal plain X-ray. The peak of clinical manifestations was in 12 h, whereas the peak liver transaminases (alanine aminotransferase (ALT), aspartate aminotransferase (AST)) and cardiac enzymes (creatine phosphokinase (CPK), creatine kinase-muscle/brain (CK-MB), troponin) were in 24 h. No fatalities were reported, 56.7% are completely cured, 37.3% are discharged on consent, and 6% are discharged with elevated liver and/or cardiac enzymes. The receiver operating characteristic (ROC) curve was applied. Persistent elevation of liver enzymes after 72 h could be predicted if the ingested amount > 3.5 (accuracy 86.2%), time till hospitalization > 5 h (accuracy 85.9%), PSS > 1 with (accuracy 58.9%), AST > 50 U/L (accuracy 86.2%), or ALT > 82 U/L (accuracy 86.3%). Elevation of cardiac enzymes could be predicted if the ingested amount > 2.5 sachets (accuracy 99.5%), time till hospitalization > 5 h (accuracy 99.7%), PSS > 1 with (accuracy 61.2%), CPK > 260 U/L (accuracy 99.9%), CK-MB > 6 ng/mL (accuracy 99.7%), or troponin > 0.9 ng/mL (accuracy 99.8%).
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Affiliation(s)
- Amal Abdelrazek Mashali
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Nagla Hasan Salama
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Heidi Ali Elsobky
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Zahraa Khalifa Sobh
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
- Faculty of Medicine, Champollion street, Alexandria, Egypt.
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