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Sadeghi M, Zakariaei Z, Rashidian H, Soleymani M. Fatal outcome due to aluminum phosphide poisoning in an old man with a psychiatric disorder as a latent post-COVID-19 challenge: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231177759. [PMID: 37293254 PMCID: PMC10247668 DOI: 10.1177/2050313x231177759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Aluminum phosphide is a metal phosphide widely implemented as a pesticide. In the country of Iran, it is recognized by the colloquial name of rice pill. Any trace of accidental or intentional ingestion of aluminum phosphidecan result in severe hemodynamic disorders and metabolic acidosis, ultimately leading to the patient's mortality. In this report, we document the unfortunate demise of an 85-year-old man who lived in isolation, having lost his wife to COVID-19. The patient consumed aluminum phosphide tablets and, despite resuscitation efforts, inevitably succumbed to the toxic effects.
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Affiliation(s)
- Mahdieh Sadeghi
- Student Research Committee, Mazandaran
University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Toxicology and Forensic Medicine Division,
Mazandaran Registry Center for Opioids Poisoning, Antimicrobial Resistance Research Center,
Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
- Iranian National Registry Center for
Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hale Rashidian
- Departments of Emergency Medicine, Mazandaran
University of Medical Sciences, Sari, Iran
| | - Mostafa Soleymani
- Iranian National Registry Center for
Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
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2
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Al-Safar AHA, Jawad RAM, Khayoon HA, Alsaadawi MA, Zenad KH, Saeed ZF, Alkhaled MJ. Biochemical and histopathological changes in livers of rats poisoned with aluminum phosphide and treated with carrot extract. Environ Anal Health Toxicol 2023; 38:e2023014-0. [PMID: 37933108 PMCID: PMC10628400 DOI: 10.5620/eaht.2023014] [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: 03/19/2023] [Accepted: 06/05/2023] [Indexed: 11/08/2023] Open
Abstract
The experimental studies of Aluminum Phosphide (AP) poisoning in rats revealed several clinical and pathological signs such as hemorrhage, sinusoidal dilatation, bile stasis, centrilobular necrosis, Kupffer cell hyperplasia, infiltration by mononuclear cells, and fatty infiltration in the liver tissues. This paper aimed to show the impact of carrots on the toxic effect of AP on the livers of adult rats (female). To investigate some biochemical and histopathological changes effects of AP in rats, sixty white female rats were equally divided into four groups, the first group (G1) was administered orally with 3mg/kg/ body weight of AP, the second group (G2) was orally treated with AP and 10% carrot extract at the same time. The third group (G3) administrated 10% carrot extract only. The fourth (G4) group was the negative control and was treated with distilled water only. The experiments continued for a month at the animal house of the Veterinary Medicine College of Baghdad University. The results revealed that high levels of liver enzymes and bilirubin were induced in G1 with decreasing total protein levels. The pathological examination revealed the presence of marked proliferation of Kupffer cells in G1 livers. However, the G2 group showed slight infiltration of lymphocytes in sinusoids. The pathological changes in the livers of G3 group showed slight cloudy swelling in hepatocytes compared with the normal texture of hepatocytes in G4. The data of this experiment showed that treatment with carrot extract significantly decreases the elevation in the level of liver function enzymes in animal poisoned with AP. In addition, treatment with carrot extract reduces the severe damage in the hepatic tissue that occurred in rats treated with AP only. In general, it could be concluded that treatment with carrot extract provides a remedial effect against the hepatotoxicity that is resulted from exposure to AP.
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Affiliation(s)
| | | | | | | | | | - Zeayd Fadhil Saeed
- Nursing department, Technical Institute of Samawah, Al Furat Al Awsat Technical University, Iraq
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3
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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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Abhilash KPP, Chandran J, Murugan S, Rabbi N AS, Selvan J, Jindal A, Gunasekaran K. Changing trends in the profile of rodenticide poisoning. Med J Armed Forces India 2022; 78:S139-S144. [PMID: 36147429 PMCID: PMC9485748 DOI: 10.1016/j.mjafi.2020.12.009] [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: 05/11/2020] [Accepted: 12/14/2020] [Indexed: 10/21/2022] Open
Abstract
Background Deliberate self-poisoning (DSP) is one of the leading causes of mortality and morbidity, with rodenticides being common compounds used by many victims. However, comprehensive data regarding the spectrum and outcome of rodenticide poisoning is scant. Method This retrospective study was conducted in the Emergency Department (ED) of a large tertiary care hospital in South India between January 2017 and December 2018. All patients with deliberate consumption of rodenticides were included in the analysis. Results During the study period, 1802 patients presented with DSP, among which 145 (8%) consumed rodenticide compounds. The mean (SD) age was 27.9 (10.7) years. Young adults (16-30 years) comprised 73% (106/145) of the study population. The majority (87%) were triaged as priority 2, while 10% were triaged as priority 1. Common rodenticide compounds consumed were yellow phosphorous (57%: 82/145), coumarins (12%: 17/145), zinc phosphide (19%: 27/145), and aluminum phosphide (1%: 1/145). A significant proportion of patients (18.6%) were under the influence of alcohol. Among the 73 males, 25 (34.2%) gave a history of co-consumption of alcohol. There was a history of previous DSP attempts in 6%. The majority (68%) of the patients were discharged alive from the hospital, and the in-hospital mortality rate was 9%. Age >30 years (adjusted OR: 2.2; 95% CI: 1.00-5.05; p value: 0.04) was an independent predictor of poor outcome. Conclusion Rodenticide compound consumption for DSP is prevalent in young adults and is associated with significant mortality, especially with yellow phosphorous poisoning. The current trend in our country of the increasing use of highly fatal phosphorous compounds over the innocuous coumarin derivatives is a cause of grave concern.
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Affiliation(s)
| | - Jolly Chandran
- Associate Physician (Paediatrics), PICU, Christian Medical College, Vellore, India
| | - Sanjay Murugan
- Paramedic (Emergency Medicine), Christian Medical College, Vellore, India
| | | | - Jagadesha Selvan
- Junior Clinical Assistant (Emergency Medicine), Christian Medical College, Vellore, India
| | - Anmol Jindal
- Junior Clinical Assistant (Emergency Medicine), Christian Medical College, Vellore, India
| | - Karthik Gunasekaran
- Assistant Professor (General Medicine), Christian Medical College, Vellore, India
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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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Bogale DE, Ejigu BD, Muche TA. Clinical Profile and Treatment Outcome of Aluminum Phosphide Poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: A Retrospective Study. Open Access Emerg Med 2021; 13:239-248. [PMID: 34163261 PMCID: PMC8216064 DOI: 10.2147/oaem.s313181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Aluminum phosphide (AlP) is an effective fumigant and rodenticide which is a commonly used agent for self-poisoning in parts of Ethiopia. AlP poisoning results in serious manifestations involving many vital organs and it has high mortality. Despite its high incidence and mortality, studies on AlP poisoning in Ethiopia are lacking. Our objective was to study the clinical profile and treatment outcome of AlP poisoning in Felege Hiwot Referral Hospital (FHRH), a major referral hospital in Ethiopia. Methods It is a retrospective study conducted over all consecutive AlP poisoning cases who presented to the emergency department (ED) of the hospital from March 2018 to August 2020. A questionnaire was used to collect data from patient medical records. All data were analyzed using SPSS 25. Results A total of 125 patients were studied. Females were 57.6% and males were 42.4%. Age of patients ranged from 12 to 60 with mean age 28.5 years. The average number of AlP tablets taken was 1.2 (3.6 gm) and the average time of arrival to hospital after AlP ingestion was 4.8 hours. Nausea and vomiting were the commonest presenting features seen in 74.4% of the cases followed by hypotension which was seen in half of the cases. A wide range of laboratory findings and complications were also observed. Cases of AlP poisoning with hypotension were managed in the ICU with dopamine infusion, magnesium sulphate, hydrocortisone, and calcium gluconate in addition to gastric lavage and fluid administration. Those cases without hypotension were managed with gastric lavage and maintenance fluid only. Overall mortality from AlP poisoning was 31.2%. Conclusion With a treatment protocol used in FHRH, mortality from AlP poisoning was 31.2%. Using this protocol in resource limited settings might give opportunities to reduce mortality from AlP poisoning.
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Yadav D, Bhattacharyya R, Banerjee D. Acute aluminum phosphide poisoning: The menace of phosphine exposure. Clin Chim Acta 2021; 520:34-42. [PMID: 34077754 DOI: 10.1016/j.cca.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 01/29/2023]
Abstract
Aluminum phosphide (AlP) is a popular fumigant used widely for the safe storage of food grain. Although A1P is free from toxic residues, it releases phosphine which acts on mitochondrial components of almost all types of pests. Unfortunately A1P is also a common suicidal agent in developing countries with no known antidote. In addition, accidental exposure to phosphine may also occur. AlP poisoning affects cardiac and vascular tissue directly and can result in multiorgan system failure leading to death in severe cases. There is no specific biomarker for diagnosing AlP poisoning and management depends on a high level of clinical suspicion. Although acetylcholinesterase has been suggested as a surrogate biomarker of AlP exposure, there are opposing views. In this review, we analyzed the relevant published material with emphasis on the need to recognize and explore the use of plasma mitochondrial enzyme activity as a potential biomarker for AlP exposure.
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Affiliation(s)
- Deepak Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajasri Bhattacharyya
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Dibyajyoti Banerjee
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Shakur AM, Garba NA, Ahmadu I, Apollos D, Asani MO, Aliyu I. Accidental poisoning with aluminum phosphide presenting with excessive cholinergic symptoms with response to atropine: A case report. Avicenna J Med 2021; 11:58-61. [PMID: 33520793 PMCID: PMC7839258 DOI: 10.4103/ajm.ajm_156_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Accidental poisoning in children, though underreported in our environment, is common and could prove fatal. It is important to identify the primary chemical agent that is responsible for the poisoning. We present a case of accidental ingestion of fish poisoned with aluminum phosphide (AlP) used as rat poisoning by a 14-month-old girl. At presentation, the actual chemical content of the poison was not available and clinical features were suggestive of organophosphate poisoning. She was commenced on atropine together with other treatment, on which she made remarkable improvement. The atropine was continued with complete resolution of symptoms on the third day of admission. We, therefore, report a serendipitous use of atropine in the management of AlP poisoning with successful outcome.
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Affiliation(s)
- Abubakar Muhammad Shakur
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Nuhu Abubakar Garba
- Department of Paediatrics, Federal Medical Centre, Nguru, Yobe State, Nigeria
| | - Ibrahim Ahmadu
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Daniel Apollos
- Department of Paediatrics, Federal Teaching Hospital, Gombe, Gombe State, Nigeria
| | - Mustafa O Asani
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Ibrahim Aliyu
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
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Khezri S, Sabzalipour T, Jahedsani A, Azizian S, Atashbar S, Salimi A. Chrysin ameliorates aluminum phosphide-induced oxidative stress and mitochondrial damages in rat cardiomyocytes and isolated mitochondria. ENVIRONMENTAL TOXICOLOGY 2020; 35:1114-1124. [PMID: 32432806 DOI: 10.1002/tox.22947] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
Apart from the anticancer, antioxidant, anti-inflammatory effects, and inhibition of aromatase, chrysin is involved in the protection of cardiovascular disorders. Cardiovascular complications are the main cause of death induced by aluminum phosphide (AlP) which is related to oxidative stress and mitochondrial damages. For this purpose, we investigated the effect of chrysin as an antioxidant and mitochondrial protective agent against AlP-induced toxicity in isolated cardiomyocytes and mitochondria obtained from rat heart ventricular. Using by biochemical and flow cytometry, cell viability, reactive oxygen species (ROS) formation, mitochondria membrane potential (MMP), lysosomal membrane integrity, malondialdehyde (MDA) content, and glutathione (GSH) and oxidized glutathione (GSSG) content were measured in isolated cardiomyocytes. Also, mitochondrial toxicity parameters such as mitochondrial NADH/succinate dehydrogenase activity, mitochondrial swelling, ROS formation, MMP collapse, and lipid peroxidation were analyzed in isolated mitochondria. Our results showed that the administration of chrysin (up to 10 μM) efficiently decreased (P < 0.05) cytotoxicity, oxidative, lysosomal, and mitochondrial damages induced by AlP, in isolated cardiomyocytes. Also, our finding in isolated mitochondria showed that chrysin (up to 10 μM) significantly (P < 0.05) decreased AlP-induced mitochondrial toxicity. These findings demonstrated that chrysin as an antioxidant and mitochondrial protective agent exert protective effect in wild-type cardiomyocyte treated with AlP. It was concluded that chrysin significantly reduced the toxicity of AlP in isolated cardiomyocytes and mitochondria. Due to the very low toxicity of chrysin for humans, it could be a promising agent in treatment of AlP poisoning.
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Affiliation(s)
- Saleh Khezri
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Towhid Sabzalipour
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Asal Jahedsani
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sepideh Azizian
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saman Atashbar
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ahmad Salimi
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
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10
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Darwish RT, Sobh ZK, Hamouda EH, Saleh EM. The efficacy of Coenzyme Q10 and liquid paraffin oil in the management of acute aluminum phosphide poisoning. Toxicol Res (Camb) 2020; 9:444-453. [PMID: 33936588 DOI: 10.1093/toxres/tfaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Abstract
Aluminum phosphide (AlP) poisoning had high morbidities and mortalities with absence of a standardized approach for the treatment. The present study investigated the efficiency of GIT decontamination methods and Coenzyme Q10(Co Q10) (Ubiquinone) in improving the outcome of acute AlP poisoning. A total of 90 patients were included and all patients received immediately supportive measures, then they distributed into three equal groups: In group I, gastric lavage was done using KMNO4 solution (1:10 000); group II received 250-500 ml liquid paraffin oil orally; group III received 300 mg of Co Q10 dissolved in liquid paraffin. Co Q10 was continued in a dose of 200 mg/day every 12 h. Follow-up blood pressure, arterial blood gases, serum troponin level and need for intubation revealed that the best improvement was in group III followed by group II. The percentage of survivors was 76.67% in group III and 70% of the patients had no residual effects. In group II, the survivors were 63.33%, and 36.67% of the cases discharged without sequelae. The survivors in group I constituted 26.67% and only 16.67% of the patients had no residual effects. GIT decontamination with aqueous solutions in acute AlP poisoning should be avoided. Rapid oral intake of any available oil as a prehospital treatment or immediately on hospital admission could critically improve the outcome of acute AlP poisoning. Besides, the addition of Co Q10 to the oil further improve patients' prognosis. HighlightsAcute aluminum phosphide (AlP) poisoning is associated with high mortalities.The appropriate method of GIT decontamination in acute AlP poisoning is controversy.Conventional gastric lavage was associated with poor prognosis in acute AlP poisoning.GIT decontamination using liquid paraffin oil improved outcome of acute AlP poisoning.Coenzyme Q10 ameliorated AlP toxicity with improvement of cardiac functions.
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Affiliation(s)
- Ragaa Talaat Darwish
- 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
| | - Emad Hamdy Hamouda
- Critical Care Medicine, Faculty of Medicine, University of Alexandria, Alexandria Governorate, Attarine 21517, Egypt
| | - Eman Mohamed Saleh
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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11
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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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12
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Garrett KK, Frawley KL, Carpenter Totoni S, Bae Y, Peterson J, Pearce LL. Antidotal Action of Some Gold(I) Complexes toward Phosphine Toxicity. Chem Res Toxicol 2019; 32:1310-1316. [PMID: 31070361 DOI: 10.1021/acs.chemrestox.9b00095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Phosphine (PH3) poisoning continues to be a serious problem worldwide, for which there is no antidote currently available. An invertebrate model for examining potential toxicants and their putative antidotes has been used to determine if a strategy of using Au(I) complexes as phosphine-scavenging compounds may be antidotally beneficial. When Galleria mellonella larvae (or wax worms) were subjected to phosphine exposures of 4300 (±700) ppm·min over a 20 min time span, they became immobile (paralyzed) for ∼35 min. The administration of Au(I) complexes auro-sodium bisthiosulfate (AuTS), aurothioglucose (AuTG), and sodium aurothiomalate (AuTM) 5 min prior to phosphine exposure resulted in a drastic reduction in the recovery time (0-4 min). When the putative antidotes were given 10 min after the phosphine exposure, all the antidotes were therapeutic, resulting in mean recovery times of 14, 17, and 19 min for AuTS, AuTG, and AuTM, respectively. Since AuTS proved to be the best therapeutic agent in the G. mellonella model, it was subsequently tested in mice using a behavioral assessment (pole-climbing test). Mice given AuTS (50 mg/kg) 5 min prior to a 3200 (±500) ppm·min phosphine exposure exhibited behavior comparable to mice not exposed to phosphine. However, when mice were given a therapeutic dose of AuTS (50 mg/kg) 1 min after a similar phosphine exposure, only a very modest improvement in performance was observed.
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Affiliation(s)
- Kimberly K Garrett
- Department of Environmental and Occupational Health, Graduate School of Public Health , The University of Pittsburgh , Pittsburgh , Pennsylvania 15219 , United States
| | - Kristin L Frawley
- Department of Environmental and Occupational Health, Graduate School of Public Health , The University of Pittsburgh , Pittsburgh , Pennsylvania 15219 , United States
| | - Samantha Carpenter Totoni
- Department of Environmental and Occupational Health, Graduate School of Public Health , The University of Pittsburgh , Pittsburgh , Pennsylvania 15219 , United States
| | - Yookyung Bae
- Department of Environmental and Occupational Health, Graduate School of Public Health , The University of Pittsburgh , Pittsburgh , Pennsylvania 15219 , United States
| | - Jim Peterson
- Department of Environmental and Occupational Health, Graduate School of Public Health , The University of Pittsburgh , Pittsburgh , Pennsylvania 15219 , United States
| | - Linda L Pearce
- Department of Environmental and Occupational Health, Graduate School of Public Health , The University of Pittsburgh , Pittsburgh , Pennsylvania 15219 , United States
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13
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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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14
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Farzaneh E, Ghobadi H, Akbarifard M, Nakhaee S, Amirabadizadeh A, Akhavanakbari G, Keyler DE, Mehrpour O. Prognostic Factors in Acute Aluminium Phosphide Poisoning: A Risk-Prediction Nomogram Approach. Basic Clin Pharmacol Toxicol 2018. [PMID: 29527823 DOI: 10.1111/bcpt.13005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aluminium phosphide (AlP) is a toxic agent associated with a high mortality rate following acute exposure from various routes. The aim of this study was to determine the clinical and laboratory findings useful for predicting the medical outcome of AlP-poisoned patients using established scoring systems. This is a prospective study of AlP-poisoned patients from 2010 to 2015 in Ardabil, Iran. All patients that presented with a confirmed diagnosis of acute AlP poisoning in the study interval were included in the study. Clinical and laboratory data, using Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scoring systems, were compared for their predictive value in determining differences between survived and non-survived patients. Univariate analysis (Mann-Whitney or t-test), multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the Pearson correlation test were performed using STATA/SE 13.0 and the Nomolog Software. A total of 68 AlP-poisoned patients with confirmed acute AlP poisoning were included for evaluation. Of these, 36 were non-survived. Multiple logistic regression analysis was performed using parameters and values derived from patient clinical and laboratory data, and revealed that four factors were significant for predicting mortality: Glasgow coma score (GCS); systolic blood pressure (SBP); urinary output (UOP); and serum HCO3 . A four-variable, risk-prediction nomogram was developed for identifying high-risk patients and predicting the risk of mortality. Study results showed that SBP of <92.5 mmHg (p = 0.006); HCO3- < 12.9 mEq/L (p = 0.01), UOP < 1725 mL/day (p = 0.04); and GCS < 14.5 (p = 0.003) were significant predictors of AlP mortality. Scoring systems analysis showed SAPS II score >24.5, APACHE II score >8.5 and SOFA score >7.5 were predictive of non-survival patients. The results of our study showed that SBP, GCS, UOP and serum HCO3 levels are the best prognostic factors for predicting mortality in AlP-poisoned patients. According to the area under the ROC curve of the APACHE II score, when compared with SOFA and SAPS II scores, the APACHE II score can more effectively discriminate between non-survivors and survived patients.
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Affiliation(s)
- Esmaeil Farzaneh
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Ghobadi
- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahdieh Akbarifard
- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | | | - Daniel E Keyler
- Department of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
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15
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Rahman NA, Das S, Chaudhari VA, Nandagopal S, Badhe B. Blending of rodenticide and battery acid - a rare and fatal suicide mix. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2017; 7:8. [PMID: 28781900 PMCID: PMC5514184 DOI: 10.1186/s41935-017-0002-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/24/2017] [Indexed: 11/16/2022] Open
Abstract
Background Self-poisoning usually occurs by the ingestion of a single lethal compound and majority of the poisoning cases in our country are due to the pesticides. Suicide by ingestion of more than one poisonous substance is rare except alcohol and multiple drugs. To the best of our knowledge, suicidal ingestion of a mixture of rodenticide and battery acid has not been reported before in medical literature. Case presentation Here we are discussing a case of simultaneous ingestion of two poisonous substances, i.e., aluminium phosphide and battery acid. In general, an acid is mainly locally acting while metal phosphide is a systemic poison. Features suggestive of both these poisonous substances were noticed on clinical, autopsy and histopathological examination and supported by a positive chemical analysis report of viscera. Moreover, we analysed the possible reactions which may occur between these two compounds and their by-products outside and inside our body. Conclusion In cases where, combination of poisons is suspected a proper history, meticulous autopsy and ancillary investigation including histopathogy and analytical toxicology are required to conclude the cause of death and mechanism of poisoning.
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Affiliation(s)
| | - Siddhartha Das
- Department of Forensic Medicine & Toxicology, JIPMER, Puducherry, India
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