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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 2024:1-17. [PMID: 38656260 DOI: 10.1080/10408444.2024.2329624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Edde P, Kortbawi AE, Halabi Z, Sakr N, Barakat A, Zahran TE. The first reported mortality from aluminum phosphide poisoning in Lebanon: a case report. Int J Emerg Med 2024; 17:18. [PMID: 38321417 PMCID: PMC10848461 DOI: 10.1186/s12245-024-00591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Aluminum phosphide is a commonly used pesticide, particularly in developing countries where uncontrolled insecticides and pesticides are commonly prevalent. Mortalities have been reported due to accidental and suicidal exposures to aluminum phosphide. To date, there has been no reported mortality case of aluminum phosphide in Lebanon. In addition, there is no specific antidote for aluminum phosphide toxicity and the treatment is mainly supportive. This is why awareness should be spread about this case to include it in the differential diagnoses and enhance prompt management and response in future encounters. CASE PRESENTATION A previously healthy 37-year-old male, presented to the emergency department of Notre Dame des Secours University Hospital Center for a suicidal attempt after ingesting 5 tablets of pesticide containing 56% aluminum phosphide an hour prior to presentation. Shortly after the presentation, the patient began deteriorating and became clinically unstable. The patient was then intubated and was started on sodium bicarbonate along with aggressive fluid resuscitation. The patient remained hypotensive even after giving vasopressors. He was then later admitted to the intensive care unit for further management. However, the patient further decompensated and developed multiorgan failure. This is the first case of mortality in Lebanon from aluminum phosphide toxicity. CONCLUSIONS Emergency physicians should include aluminum phosphide toxicity in the differential diagnosis when dealing with patients ingesting unknown pesticides especially when they smell the characteristic garlic-like odor. The toxicity from ALP leads to multiorgan failure and death rapidly. Thus, it is of utmost importance to start early, and aggressive resuscitation given that there is no specific antidote.
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Affiliation(s)
- Pierre Edde
- Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon / School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O.Box 446, Jounieh, Lebanon
| | - Anthony El Kortbawi
- Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon / School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O.Box 446, Jounieh, Lebanon
| | - Zeina Halabi
- Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Nancy Sakr
- Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon / School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O.Box 446, Jounieh, Lebanon
| | - Alondra Barakat
- Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Tharwat El Zahran
- Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
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Adel B, Elgharbawy NM, Shahin MM, Abo-Elfadl AA, Saad KM. Insulin-euglycemia therapy in acute aluminum phosphide poisoning: a randomized clinical trial. Clin Toxicol (Phila) 2023; 61:1032-1039. [PMID: 38096041 DOI: 10.1080/15563650.2023.2279495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/31/2023] [Indexed: 01/26/2024]
Abstract
Introduction: Aluminum phosphide is a pesticide that is used in developing countries. Aluminum phosphide poisoning has a high mortality rate and there is no known antidote. This study aimed to evaluate the safety and efficacy of insulin-euglycemia therapy in the management of patients with acute aluminum phosphide poisoning.Methods: This trial was prospectively registered in the Pan African Clinical Trials Registry (PACTR202008534546951). A total of 108 patients were randomly allocated to two groups. The intervention group received insulin-euglycemia therapy in addition to standard treatment (norepinephrine and supportive care); the control group received standard treatment plus placebo. The main outcome measures were survival, blood pressure, and laboratory investigations.Results: The two groups had similar baseline parameters. Insulin-euglycemia therapy was associated with a significant reduction in mortality compared with that in the control group (64.8 percent and 96.3 percent, respectively; P value <0.001). Patients randomized to insulin-euglycemia also required lower doses of vasopressors (median was 7 mg versus 26 mg in control group; P value 0.006) and fewer patients needed intubation (61.1 percent versus 81.5 percent in the control group; P value 0.019). Insulin-euglycemia therapy significantly improved blood pressure (systolic, diastolic, and mean arterial pressure) (median at 6h post-admission was 80 mmHg, 55 mmHg and 65 mmHg compared with 20 mmHg, 10 mmHg and 13 mmHg in the control group respectively; P value <0.001) and bicarbonate and lactate concentrations.Conclusion: Insulin-euglycemia therapy appears to be a safe and effective treatment option for patients with aluminum phosphide poisoning. Vasopressor only therapy was associated with very poor outcomes in acute aluminum phosphide poisoning.
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Affiliation(s)
- Basma Adel
- Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt
| | | | - Marwa Mohamed Shahin
- Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt
| | - Arwa Ahmed Abo-Elfadl
- Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt
| | - Khaled Mahmoud Saad
- Department of Forensic Medicine and Clinical Toxicology, Tanta University, Tanta, Egypt
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Yang Y, Bustani GS, Alawsi T, Altalbawy FMA, Kareem AK, Gupta J, Zhu P, Hjazi A, Alawadi AH, Mustafa YF. The cardioprotective effects of cerium oxide nanoparticles against the poisoning generated by aluminum phosphide pesticide: Controlling oxidative stress and mitochondrial damage. Pestic Biochem Physiol 2023; 197:105701. [PMID: 38072556 DOI: 10.1016/j.pestbp.2023.105701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Aluminum phosphide (AlP) is a well-known toxic compound used as an agricultural pesticide to prevent insect damage to stored crops. However, even if just a small amount was consumed, it caused lasting harm to the human body and, in acute concentrations, death. The current study employed cerium oxide nanoparticles (CeO2 NPs) to reduce oxidative stress and various harmful outcomes of AlP poisoning. METHODS Following finding effective concentrations of CeO2 NPs via MTT assay, Human Cardiac Myocyte (HCM) cells were pre-treated with CeO2 NPs for 24 h. After that, they were exposed to 2.36 μM AlP. The activity of oxidative stress and mitochondrial biomarkers, including mitochondrial swelling, mitochondrial membrane potential, and cytochrome c release, were evaluated in HCM cells. Finally, the population of apoptotic and necrotic cells was assessed via flow cytometry. RESULTS After 24 h, data revealed that all tested concentrations of CeO2 NPs were safe, and 25 and 50 μM of that were selected as effective concentrations. Oxidative stress markers (malondialdehyde, protein carbonyl, superoxide dismutase, and catalase) showed that CeO2 NPs could successfully decrease AlP poisoning due to their antioxidant characteristics. Mitochondrial markers were also recovered by pre-treatment of HCM cells with CeO2 NPs. Furthermore, pre-treating with CeO2 NPs could compensate for the reduction of live cells with AlP and cause a diminishing in the population of early and late apoptotic cells. CONCLUSION As a result, it is evident that CeO2 NPs, through the recovery of oxidative stress and mitochondrial damages caused by AlP, reduce apoptosis and have therapeutic potentials on HCM cells.
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Affiliation(s)
- Yongzheng Yang
- The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Taif Alawsi
- Scientific Research Center, Al-Ayen University, Thi-Qar, Iraq
| | - Farag M A Altalbawy
- National Institute of Laser Enhanced Sciences (NILES), University of Cairo, Giza 12613, Egypt
| | - Ali Kamil Kareem
- Biomedical Engineering Department, College of Engineering and Technologies, Al-Mustaqbal University, Hillah, Iraq
| | - Jitendra Gupta
- Institute of Pharmaceutical Research, GLA University, Mathura 281406, U. P., India
| | - Ping Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Ahmed Hjazi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | | | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul 41001, Iraq
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Shaker HO, Rageh OES, Alnajar M, Alshamaly NF, Abdelmaged WA, Abd-ElGawad M. Efficacy of intravenous N acetylcysteine as an adjuvant therapy in the treatment of acute aluminum phosphide Poisoning: a systematic review and meta-analysis. BMC Pharmacol Toxicol 2023; 24:59. [PMID: 37924139 PMCID: PMC10625249 DOI: 10.1186/s40360-023-00699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Aluminum phosphide toxicity is a serious problem in many countries. Unfortunately, there is no specific antidote. N-acetylcysteine has been used in some studies as adjuvant therapy depending on to its antioxidant properties. We hypothesized that IV N-acetylcysteine is effective in reducing mortality rate compared to supportive treatment alone. METHODS We searched in PubMed, Scopus, Web of Science, and Cochrane Library databases. We only included randomized controlled trials that assessed the efficacy of IV N-acetylcysteine and supportive treatment versus supportive treatment alone in acute aluminum phosphide poisoning. Four investigators independently screened the studies' results and designed the data extraction sheet. The primary and secondary outcomes were mortality and the need for mechanical ventilation rates. Random effects estimators with weights were used to result in the pooled risk ratios. RESULTS We included four randomized controlled trials with 177 patients. 91 patients were distributed in N-acetylcysteine group and 86 patients in the control group. Mortality rates in N-acetylcysteine group and in the control group were 43.95% 66.27% respectively. There was a statistically significant reduction in mortality rate after leave out test (pooled risk ratio, 0.5; 95% confidence interval, 0.32-0.77). Regarding the need for mechanical ventilation, it was measured only in three RCTs. It was assessed in 67 patients in N-acetylcysteine group and 60 patients in the control group. 24 patients were ventilated in N-acetylcysteine group (35.8%) and 29 patients in the control group (48.3%). But it was statistically nonsignificant (pooled risk ratio, 0.71; 95% confidence interval, 0.48-1.04). CONCLUSION Our meta-analysis revealed that IV N-acetylcysteine may be effective in reducing mortality of severe aluminum phosphide poisoning cases. TRIAL REGISTRATION Registration number in Prospero CRD42022375344 on 25 NOVEMBER 2022, retrospectively registered.
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Affiliation(s)
- Heba Othman Shaker
- Supervisor of clinical pharmacy units, Alexandria Main University Hospital, Alexandria, Egypt.
| | | | - Maged Alnajar
- Faculty of pharmacy, Alhikma University, Taiz, Yemen
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Niknahad H, Heidari R, Jangjou A, Asghari V, Niknahad FM, Goudarzi F, Tavakoli N, Rahimi M, Niknahad AM, Rashedinia M. The therapeutic effect of a novel parenteral formulation of dihydroxyacetone in aluminum phosphide-intoxicated patients. Heliyon 2023; 9:e22165. [PMID: 38053886 PMCID: PMC10694179 DOI: 10.1016/j.heliyon.2023.e22165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Background and objectives Aluminum phosphide (AlP), known as "rice tablet," is widely used as an effective pesticide. However, AlP poisoning is a common cause of mortality in many countries, such as Iran. Unfortunately, there is no specific antidote for AlP toxicity to date. AlP releases phosphine gas when it is exposed to moisture or acid. Phosphine is a potent mitochondrial toxin that could significantly inhibit cellular energy metabolism. AlP poisoning is an emergency condition that needs instant and effective intervention. Dihydroxyacetone (DHA) is a simple saccharide used for several pharmacological as well as cosmetic purposes. Previously, we found that DHA could significantly prevent mitochondrial impairment induced by toxic agents such as cyanide and phosphine in various in vitro and in vivo experimental models. Methods Hospitalized patients (n = 111) were evaluated for eligibility criteria. Among these patients, n = 35 cases were excluded due to incomplete data (n = 11) and suspicion of poisoning with poisons other than AlP (n = 24). Meanwhile, n = 76 cases with confirmed AlP poisoning were included in the study. AlP-poisoned patients who did not receive DHA (n = 18) were used as the control group.Patients (n = 58) received at least one dose of DHA (500 ml of 5 % DHA solution w/v, i.v.) as an adjuvant therapy in addition to the routine treatment of AlP poisoning. Arterial blood gas (ABG), blood pH, bicarbonate levels, and other vital signs and biochemical measurements were monitored. Moreover, the mortality rate and hospitalization time were evaluated in DHA-treated and AlP-poisoned patients without DHA administration. Several biomarkers were assessed before (upon hospitalization) and after DHA treatment. The routine tests for AlP-poisoned patients in this study were the measurement of electrolytes (K+ and Na+), WBC, RBC, hemoglobin, INR, carbonate (HCO3), blood pH, PaCO2, and PaO2 and SGPT, SGOT, BUN, Cr. Results Upon patients' admission, significant decreases in blood pH (acidosis), blood PaO2, and HCO3 levels were the hallmarks of AlP poisoning. It was found that DHA significantly alleviated biomarkers of AlP poisoning and tremendously enhanced patients' survival rate (65.52 % in DHA-treated vs 33.34 % in the control group) compared to patients treated based on hospital routine AlP poisoning protocols (no DHA). No significant adverse effects were evident in DHA-treated patients in the current study. Interpretation and conclusions These data suggest that parenteral DHA is a novel and effective antidote against AlP poisoning to be used as an adjuvant in addition to routine supportive treatment. Trial registration IR.SUMS.REC.1394.102.
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Affiliation(s)
- Hossein Niknahad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Heidari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Jangjou
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Fazel Goudarzi
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasim Tavakoli
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Rahimi
- Toxicological Research Center, Excellence Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Marziye Rashedinia
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Ghasemi H, Motevali Manesh SF, Kheiripour N, Asl SS, Jouzdani AF, Ranjbar A, Abdolvahab MH. An Oxidative Stress Study on Curcumin and Nanocurcumin against Aluminum phosphide-induced Kidney Injury in Rats: The Role of SIRT1/FOXO3 Signaling Pathway in Nephrotoxicity. Pharm Nanotechnol 2023:PNT-EPUB-133878. [PMID: 37605419 DOI: 10.2174/2211738511666230821124704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION In this study, we have investigated the aluminium phosphide (ALP) toxicity on Renal Function and oxidative stress in kidney tissue of male rats and the possible protective role of Curcumin and nanoCurcumin against ALP-induced nephrotoxicity. METHODS Thirty-six adult male rats were divided into 6 groups (n=6). ALP (2 mg/kg oral administration) and control groups received Curcumin and nanoCurcumin (oral administration 100 mg/kg ( or without it. After seven days of treatment, kidney parameters, oxidative stress biomarkers, and expression level of sirtuins1 (SIRT1)/Forkhead box protein O1 (FoxO1) pathway genes were evaluated in kidney tissue. In addition, histopathological changes in the kidney tissues were assayed. RESULTS In the ALP group, compared to the control group, lipid peroxidation levels, urea, and creatinine were increased, and total antioxidant capacity and thiol groups decreased significantly P<0.05. In Curcumin and nanoCurcumin groups compared to the ALP group, lipid peroxidation and creatinine decreased significantly P<0.05. Also, Curcumin and nanoCurcumin improved the tissue damage caused by ALP. NanoCurcumin modulated the effect of ALP on the gene expression levels in SIRT1/FoxO1. CONCLUSION The present study showed that ALP intoxication in kidney tissue can induce oxidative damage. Moreover, Curcumin and nanocurcumin, as potential antioxidants, can be effective therapeutics in ALP-induced nephrotoxicity.
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Affiliation(s)
- Hassan Ghasemi
- Department of Clinical Biochemistry, Abadan School of Medical Sciences, Abadan, Iran
| | | | - Nejat Kheiripour
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Sara Soleimani Asl
- Anatomy Departments, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Irann
| | - Ali Fathi Jouzdani
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
- USERN office, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Ranjbar
- Department of Pharmacology and Toxicology, School of Pharmacy, Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohadeseh Haji Abdolvahab
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran 1517964311, Iran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Eizadi-Mood N, Momenzadeh M, Sadeghi M, Yaraghi A, Sabzghabaee AM, Alfred S. Toxicoepidemiology of Phosphide Poisoning in the Central Part of Iran. J Res Pharm Pract 2023; 12:21-28. [PMID: 38213604 PMCID: PMC10779690 DOI: 10.4103/jrpp.jrpp_20_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/29/2023] [Indexed: 01/13/2024] Open
Abstract
Objective Aluminum phosphide (ALP) and zinc phosphide (ZnP) are toxic agrochemical pesticides, which are commonly used as an agent of self-harm in developing countries. Because of high toxicity of phosphides, we evaluated toxico-epidemiology ALP and ZnP poisoning in with respect to outcome. Methods We performed a cross-sectional study with retrospective chart review including the records for patients admitted due to phosphide poisoning (ALP, ZnP) in a poisoning referral center in Khorshid Hospital, affiliated with Isfahan University of Medial Sciences, Isfahan, Iran. Demographic characteristics, clinical manifestations, outcome (survived or death), and length of hospital stay for the patients were recorded in a data collecting form. Binary backward stepwise logistic regression was used for outcome prediction. Findings Sixty patients were evaluated in the study. The mean age of patients was 27.61. Thirty-nine patients were men. 96.7% of the patients ingested it intentionally. Most of the patients on admission were conscious (66.7%). Abnormality of EKG was noted in 8.3%. The mortality in ALP and ZnP poisoning was 39.2% and 22.2%, respectively. Serum bicarbonate and base excess in the venous blood gas analysis, systolic blood pressure, and serum sodium level were significantly different between patients with ALP and ZnP poisoning on admission time (P < 0.05). On admission, systolic blood pressure was an important predictive factor for mortality (odds ratio 4.87; 95% confidence interval: 1.5-15.45; P = 0.007). Conclusion The rate of mortality in phosphide poisoning is high. Knowing predictive factors for mortality help physicians for selecting patients in intensive care unit admission and aggressive treatment.
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Affiliation(s)
- Nastaran Eizadi-Mood
- Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Momenzadeh
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Department of Radiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Yaraghi
- Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mohammad Sabzghabaee
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sam Alfred
- Department of Emergency Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia
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10
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Jafari-Garageshlaghi F, Hashtarkhani F, Soraya H, Malekinejad H. Quercetin Protected from Aluminum Phosphide-induced Acute and Subacute Cardio- and Hepatotoxicity in Rats. Curr Pharm Des 2022; 28:3513-3524. [PMID: 36453481 DOI: 10.2174/1381612829666221130123706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/01/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Aluminum phosphide (ALP) intoxication either accidentally or intentionally, is one of the major health concerns in developing countries. Its poisoning causes severe damage to organs including the heart and liver. OBJECTIVES This study aimed to investigate the hepato- and cardioprotective effects of quercetin (QCN) on the acute/subacute toxicity of ALP in rodent models. METHODS Acute (single dose, 12.5 mg/kg, orally) and subacute (2 mg/kg, orally and 7 days) intoxication of ALP were induced in rats and the protective effects of QCN on altered hepatic/cardiac functional enzyme concentrations, myeloperoxidase activity, oxidative stress biomarkers, and histopathological changes were studied at three doses of 10, 50 and 100 mg/kg BW. To record any heart abnormality, an electrocardiogram (ECG) was recorded 3 h after the last treatment. RESULTS Quercetin reduced the ALP-increased hepatic and cardiac functional enzyme concentrations and myeloperoxidase activity. Moreover, QCN improved remarkably the ALP-induced ECG abnormalities (T inversion, bigeminy in R waves) and arrhythmias. QCN attenuated significantly (p < 0.05) the ALP-induced oxidative/ nitrosative stress and histopathological injuries in the liver and heart. CONCLUSION Our results suggest that QCN is able to protect the ALP-induced cardiac and hepatic injuries in both acute and subacute models and its effects attribute to its antioxidant and anti-inflammatory properties.
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Affiliation(s)
- Fatemeh Jafari-Garageshlaghi
- Experimental & Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Fatemeh Hashtarkhani
- Experimental & Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Soraya
- Experimental & Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Hassan Malekinejad
- Experimental & Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
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11
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Voicu S, M'Rad A, Malissin I, Deye N, Mégarbane B. Extracorporeal life support in cardiotoxicant poisoning - a narrative review. Basic Clin Pharmacol Toxicol 2022; 132:5-20. [PMID: 36197954 DOI: 10.1111/bcpt.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/01/2022]
Abstract
Extracorporeal life support (ECLS) improves circulation in life-threatening cardiac dysfunction or arrest patients. Its benefits in drug-induced cardiovascular complications are debated. Indications and outcomes are poorly established. We performed a narrative review discussing ECLS indications, timing, and results in cardiotoxicant-poisoned patients. The review was focused on antiarrhythmic drugs and aluminum phosphide. Literature analysis was limited to the past 30 years in adults. Most reports were single cases and retrospective except one prospective case series of limited size, two of them controlled. ECLS indications and timing were at the discretion of physicians in charge but mostly included persistent cardiovascular failure despite elevated doses of inotropic/vasopressor support associated with elevated blood lactate concentrations (usually, >5mmol/L) and collapsed left ventricular ejection fraction (LVEF; usually, ≤40%). Survival improved using ECLS versus standard care in one study. Survival was ~80% if ECLS was implemented in refractory cardiovascular failure and 25-66% if implemented in cardiac arrest. In two controlled studies, survival of ECLS-treated aluminum phosphide-poisoned patients was improved versus standard care, if implemented in the presence of systolic blood pressure≤80mmHg despite inotropic/vasopressor treatment, arterial pH≤7.0, and LVEF≤40%. Despite low-to-moderate level of evidence, ECLS seems effective to improve survival in selected cardiotoxicant-poisoned patients. Selection criteria need clarification.
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Affiliation(s)
- Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | - Aymen M'Rad
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | - Isabelle Malissin
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
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12
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Sedaghattalab M. Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report. J Med Case Rep 2022; 16:192. [PMID: 35578361 PMCID: PMC9112492 DOI: 10.1186/s13256-022-03425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aluminum phosphide (rice tablet) is a highly efficient agent for preserving grains against rodents and insects. It accounts for a large number of poisoning cases. Aluminum phosphide poisoning has a high mortality rate of about 90%, and to date, no antidote is available. It releases phosphine gas after exposure to moisture, and this reaction is catalyzed by the acidity of the stomach. Phosphine is then absorbed throughout the respiratory or gastrointestinal tracts and causes toxicity through inhibition of cytochrome c oxidase and formation of highly reactive free radicals. Treatment of patients with aluminum phosphide poisoning is supportive, including mechanical ventilation and vasopressors. The usage of infusion of glucose-insulin-potassium in rice tablet poisoning has been suggested, after its positive beneficial cardiac inotropic effects in patients with beta-blocker and calcium channel blocker poisoning. CASE PRESENTATION We report the case of a 30-year-old Iranian woman with critical aluminum phosphide poisoning, presented with hypotension and other signs of shock and severe metabolic acidosis, successfully treated with high-dose regular insulin and hypertonic dextrose and discharged from hospital in good condition. In contrast to our previous experiences, in which nearly all patients with critical aluminum phosphide poisoning died, this patient was saved with glucose-insulin-potassium. CONCLUSION Aluminum phosphide poisoning has a high mortality rate, and to date, no antidote is available. Administration of high-dose intravenous regular insulin and dextrose is suggested as a potential life-saving treatment for patients with critical aluminum phosphide poisoning.
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Affiliation(s)
- Moslem Sedaghattalab
- Department of Internal Medicine, Emam Sajad Hospital, Yasuj University of Medical Sciences, Yasuj, Iran.
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13
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El-Sarnagawy GN, Abdelnoor AA, Abuelfadl AA, El-Mehallawi IH. Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients. Environ Sci Pollut Res Int 2022; 29:33999-34009. [PMID: 35031983 DOI: 10.1007/s11356-021-17790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
The decision of intensive care unit (ICU) admission in acute pesticide poisoning is often challenging, especially in developing countries with limited resources. This study was conducted to compare the efficacy of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Modified Early Warning Score (MEWS), and Poisoning Severity Score (PSS) in predicting ICU admission and mortality of acute pesticide-poisoned patients. This prospective cohort study included all patients admitted to Tanta University Poison Control Center with acute pesticide poisoning from the start of March 2018 to the end of March 2019. Patient data, including demographic and toxicological data, clinical examination, laboratory investigation, and score values, were collected on admission. Out of 337 acute pesticide-poisoned patients, 30.5% were admitted to the ICU, including those poisoned with aluminum phosphide (ALP) (81.5%) and organophosphates (OP) (18.5%). Most non-survivors (86.6%) were ALP poisoning. The PSS had the best discriminatory power in predicting ICU admission and mortality, followed by APACHE II and MEWS. However, no significant difference in predicting ICU admission of OP-poisoned patients was detected between the scores. Additionally, no significant difference in mortality prediction of ALP-poisoned patients was found between the PSS and APACHE II. The PSS, APACHE II, and MEWS are good discriminators for outcome prediction of acute pesticide poisoning on admission. Although the PSS showed the best performance, MEWS was simpler, more feasible, and practicable in predicting ICU admission of OP-poisoned patients. Moreover, the APACHE II has better sensitivity for mortality prediction of ALP-poisoned patients.
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Affiliation(s)
- Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, 6th floor, Medical Colleges Complex, El-Gaish Street, Tanta, Gharbia, 31527, Egypt.
| | - Amira A Abdelnoor
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, 6th floor, Medical Colleges Complex, El-Gaish Street, Tanta, Gharbia, 31527, Egypt
| | - Arwa A Abuelfadl
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, 6th floor, Medical Colleges Complex, El-Gaish Street, Tanta, Gharbia, 31527, Egypt
| | - Inas H El-Mehallawi
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, 6th floor, Medical Colleges Complex, El-Gaish Street, Tanta, Gharbia, 31527, Egypt
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14
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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. Environ Sci Pollut Res Int 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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Kumar PH, Kalluraya MA, Jithendra C, Kumar A, Kanavehalli SP, Furtado AD, Mehta R. Venoarterial Extracorporeal Membrane Oxygenation is Effective in Severe Aluminum Phosphide Overdose Despite Delayed Presentation. Indian J Crit Care Med 2022; 25:1459-1461. [PMID: 35027809 PMCID: PMC8693114 DOI: 10.5005/jp-journals-10071-24041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aluminum phosphide (ALP) is a potentially lethal poison. The mortality rate in ALP overdose is close to 100%. ALP has no specific antidote, and only supportive therapy is possible, with timely extracorporeal support mentioned as a modality. We present a case of severe ALP overdose in a young female with delayed presentation (>24 hours) and multiorgan failure (MOF)/shock successfully managed with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Unique features of this case include consumption of lethal quantity of ALP (5 g), severe toxicity with MOF, and shock secondary to a delayed presentation, all of which incrementally added to a high mortality. This was managed with the help of VA-ECMO as a last option with a successful outcome. This highlights the fact that late ECMO deployment, despite absorption of a large quantity and MOF/shock/acidosis, can still be salvageable with appropriate management.
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Affiliation(s)
- Pradeep Hg Kumar
- Department of Pulmonology and Critical Care Medicine, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Madhusudan A Kalluraya
- Department of Pulmonology and Critical Care Medicine, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - C Jithendra
- Department of Critical Care Medicine, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Ashwin Kumar
- Department of Critical Care Medicine, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Sudhindra P Kanavehalli
- Department of Pulmonology and Critical Care Medicine, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Arul D Furtado
- Department of Cardiovascular and Thoracic Surgery, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Ravindra Mehta
- Department of Pulmonology and Critical Care Medicine, Apollo Speciality Hospital, Bengaluru, Karnataka, India
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17
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Bagherian F, Kalani N, Rahmanian F, Abiri S, Hatami N, Foroughian M, Mehramiz NJ, Shahi B. Aluminum Phosphide Poisoning Mortality Rate in Iran; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med 2021; 9:e66. [PMID: 34870232 PMCID: PMC8628645 DOI: 10.22037/aaem.v9i1.1396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: According to statistics provided by the forensic medicine facility of Iran, there are a high number of Aluminum phosphide (ALP) poisoning-related deaths in the country; while the mortality rate varies in different studies. This study aimed to determine a pooled estimate of ALP poisoning mortality rate in Iran. Methods: The present study was a systematic review and meta-analysis of the mortality rate of ALP poisoning in Iran. Through the quarry of Persian and English databases, using “aluminum phosphide”, “phosphine”, “rice pills”, “poisoning”, and “Iran” as keywords, and no time restrictions, studies reporting mortality rate in ALP poisoning cases were collected. The random-effects model was used to pool the proportions of mortality and age of survivors versus non-survivors. Results: 21 studies with 3432 cases of ALP poisoning were included in this meta-analysis. The pooled mortality rate of ALP poisoning in Iran was 39.6%, (95% CI: 31.5%-47.9%; I2 = 95%). Since there was significant publication bias, the trim-and-fill correction was conducted and the corrected pooled mortality rate was estimated to be 27.3% (95% CI: 18.9%- 36.5%), which is the rate that should be considered for clinical guidance. Morality rate in male and female patients was 62.3% (95% CI: 53.5%-70.8%) and 37.7% (95% CI: 29.2%-46.5%), respectively (p < 0.01). Survivors had significantly lower mean age than non-survivors (SMD: -0.26 (95% CI: -0.37 to -0.15); p < 0.01; I2=0%). Conclusion: According to this report, the Mortality rate of ALP poisoning in Iranian population is about 27%, with men having a higher fatality rate than women. Poisoning at a younger age is associated with better results.
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Affiliation(s)
- Farhad Bagherian
- Department of Emergency Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Navid Kalani
- Research center for social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Fatemeh Rahmanian
- Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Samaneh Abiri
- Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Naser Hatami
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neema John Mehramiz
- Department of Psychiatry Neurology, Banner university medical center, Tucson, AZ, USA
| | - Behzad Shahi
- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Katwal S, Malbul K, Mandal SK, KC S, Alam MZ, Karki P, Pant C. Successfully managed aluminum phosphide poisoning: A case report. Ann Med Surg (Lond) 2021; 70:102868. [PMID: 34603718 PMCID: PMC8463823 DOI: 10.1016/j.amsu.2021.102868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION and Importance: Aluminum phosphide (ALP) is a commonly available pesticide in agricultural countries like Nepal. Upon ingestion, this releases highly toxic phosphine gas in the gastrointestinal tract when it comes in contact with humidity. This leads to refractory shock, metabolic acidosis, cardiac arrhythmia, renal failure, and hepato-biliary impairment. CASE PRESENTATION We present a successfully managed case of a 17-year-old girl who ingested 6 g (2 tablets) of ALP tablets with suicidal intent. Although the mortality has been reported as 70-100% with mere ingestion of 150-500 mg of ALP, this case survived even after developing severe metabolic acidosis, acute renal failure, refractory shock, and ventricular tachycardia. CLINICAL DISCUSSION ALP poisoning is most often lethal. However, there is an emerging evidence of successful use of various drugs such as magnesium sulfate, trimetazidine, and other interventions such as intra-aortic balloon pump and extra corporeal membrane oxygenation in case of ALP poisoning. CONCLUSION Owing to the unavailability of an effective antidote of ALP to date, we emphasize early initiation of supportive management, intensive monitoring, and potential role of membrane stabilizers like magnesium sulfate, and cardio-protective agents like trimetazidine, N-Acetyl cysteine, thiamine, vitamin C, and hydrocortisone in decreasing the likelihood of fatal outcome.
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Affiliation(s)
| | - Kiran Malbul
- Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | | | - Soniya KC
- Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Md Zafar Alam
- Department of Medicine, Resident of Internal Medicine, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Parag Karki
- Department of Medicine, Faculty of Internal Medicine, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Chiranjibi Pant
- Department of Medicine, Faculty of Internal Medicine, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
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20
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Bameri B, Armandeh M, Baeeri M, Haghi-Aminjan H, Rahimifard M, Hassani S, Hooshangi Shayesteh MR, Samadi M, Gholami M, Nayebpour M, Ostad SN, Abdollahi M. Electrocardiographic, hemodynamic, and biochemical evidence on the protective effects of exenatide against phosphine-induced cardiotoxicity in rat model. Hum Exp Toxicol 2021; 40:S381-S396. [PMID: 34569344 DOI: 10.1177/09603271211040819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aluminum phosphide (AlP) poisoning can be deadly in most cases targeting the heart. To overcome AlP toxicity, exenatide has been studied in the present study due to its pleiotropic effects on cardiac damages. In this study, the rats were exposed to LD50 of AlP (10 mg/kg) by gavage, and exenatide at doses (0.05, 0.1, and 0.2 mg/kg) injected intraperitoneally 30 min after poisoning. The cardiac parameters including heart rate (HR), blood pressure (BP), QRS, corrected QT (QTc), and ST were monitored for 180 min. Blood glucose level was measured in the study groups 30 min after exenatide injection. Evaluation of biochemical parameters including mitochondrial complexes I, II, and IV activities, adenosine diphosphate (ADP)/adenosine triphosphate (ATP) ratio, malondialdehyde (MDA), apoptosis, lactate, troponin I, and brain natriuretic peptide (BNP) was done on heart tissues after 12 and 24 h. Additionally, the tissues were analyzed for any pathological damages including necrosis, hemorrhage, or hyperemia 24 h post-treatment. Our results showed that AlP-induced HR, BP, and electrocardiographic changes were improved by exenatide at all doses. The blood glucose levels of poisoned animals reached control levels after exenatide treatment. Besides, treatment with exenatide at all doses improved complexes I and IV activity, ADP/ATP ratio, and apoptosis. Malondialdehyde, lactate, troponin I, and BNP levels were also diminished after exenatide co-treatment in poisoned animals. On the other hand, administration of exenatide doses improved the histopathology of AlP-induced tissues. Based on our findings, exenatide has a protective effect against phosphine-induced cardiotoxicity in an almost dose-dependent way. However, further investigations are needed on the potential clinical use of exenatide in this poisoning.
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Affiliation(s)
- Behnaz Bameri
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, 48439Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Armandeh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, 48439Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Baeeri
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Haghi-Aminjan
- Pharmaceutical Sciences Research Center, 48413Ardabil University of Medical Sciences, Ardabil, Iran.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, 48413Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahban Rahimifard
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Shokoufeh Hassani
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Hooshangi Shayesteh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, 48439Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mahedeh Samadi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Gholami
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Nayebpour
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, 48439Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyed Nasser Ostad
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, 48439Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, 48439Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), 48439Tehran University of Medical Sciences, Tehran, Iran
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21
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Shin HY, An JS, Lee JM, You SG, Shin IS. Phosphine residues and physicochemical stability of Hwangtae after fumigation. Food Sci Biotechnol 2021; 30:1025-1031. [PMID: 34471557 DOI: 10.1007/s10068-021-00944-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Abstract
This study detected phosphine residues and the qualitative effect of phosphine fumigation on Hwangtae (yellowish-dried Alaska pollock). Four types of Hwangtae products commercially purchased were investigated to assess phosphine residue. Hwangtae was fumigated at both laboratory scale, at an aluminum phosphide rate of 33.6 g/m3, and large scale (1.68 g/m3) to evaluate phosphine residue and dissipation. Further, nutritional composition analyses between pre- and post-fumigated Hwangtae were conducted. The concentration of phosphine residues was lower than the detection limit (0.005 mg/kg) in all Hwangtae products. After fumigation in laboratory scale, phosphine residue was 2.47 mg/kg, and after fumigation in large scale, the residue was 3.25 mg/kg. After 3-d aeration in the open air, there was no residue detected from fumigated Hwangtae. Nutritional composition, including proximate, mineral, and amino acid compositions, did not differ (P > 0.05) between pre- and post-fumigated Hwangtae. Overall, Hwangtae did not demonstrate a phosphine residue problem after the proper aeration process, and phosphine did not alter the nutritional composition, suggesting the use of phosphine as a fumigant to protect Hwangtae from insect pests.
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Affiliation(s)
- Hye Young Shin
- Department of Marine Food Science and Technology, College of Life Sciences, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung-si, Gangwon-do 25457 Republic of Korea
| | - Ji Seop An
- Department of Marine Food Science and Technology, College of Life Sciences, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung-si, Gangwon-do 25457 Republic of Korea
| | - Ji Min Lee
- Department of Marine Food Science and Technology, College of Life Sciences, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung-si, Gangwon-do 25457 Republic of Korea
| | - Sang Guan You
- Department of Marine Food Science and Technology, College of Life Sciences, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung-si, Gangwon-do 25457 Republic of Korea
| | - Il Shik Shin
- Department of Marine Food Science and Technology, College of Life Sciences, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung-si, Gangwon-do 25457 Republic of Korea
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22
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Samadi M, Baeeri M, Haghi-Aminjan H, Rahimifard M, Gholami M, Hassani S, Sattari M, Azarmi Y, Bameri B, Armandeh M, Hooshangi Shayesteh MR, Eghbal MA, Abdollahi M. On the mechanisms of taurine in alleviating electrocardiographic, hemodynamic, and biochemical parameters following aluminum phosphide cardiotoxicity. Food Chem Toxicol 2021; 154:112347. [PMID: 34139304 DOI: 10.1016/j.fct.2021.112347] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Aluminum phosphide (AlP) causes severe cardiotoxicity. Taurine has been chosen for the present study because of its positive known effects on cardiac injuries. METHOD To evaluate AlP-induced cardiotoxicity, the animals were divided into seven groups, including the control group, the taurine group (500 mg/kg), AlP with LD50 dose, AlP + taurine 20, 50, 100, and 200 mg/kg group. To assess cardiac hemodynamic parameters, Wistar rats received taurine intraperitoneally 60 min after AlP gavage. Cardiac hemodynamic parameters were evaluated for 180 min. To study biochemical parameters, 24 h after AlP treatment, the animals were sacrificed, and heart tissues were collected. RESULT ECG, BP, and HR abnormalities of AlP poisoning were improved by taurine treatment. AlP induced biochemical alterations including complexes I and IV activities, the ADP/ATP ratio, mitochondrial membrane potential, cytochrome C release, and oxidative stress biomarkers ameliorated by taurine. Moreover, taurine improved apoptosis, as well as lessened CK-MB and troponin I levels. Also, there were no significant changes between taurine 500 mg/kg and the control group in tests. CONCLUSION The present findings showed that taurine could be a possible candidate for AlP cardiotoxicity treatment via the effect on mitochondrial electron transfer chain and maintaining intracellular ATP balance.
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Affiliation(s)
- Mahedeh Samadi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Baeeri
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Haghi-Aminjan
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahban Rahimifard
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Gholami
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Shokoufeh Hassani
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Sattari
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yadollah Azarmi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnaz Bameri
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Armandeh
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Hooshangi Shayesteh
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad A Eghbal
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.
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23
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Armandeh M, Bameri B, Baeeri M, Haghi-Aminjan H, Rahimifard M, Hassani S, Hooshangi Shayesteh MR, Khalid M, Samadi M, Hosseini R, Masoudi Fard M, Abdollahi M. The role of levosimendan in phosphine-induced cardiotoxicity: evaluation of electrocardiographic, echocardiographic, and biochemical parameters. Toxicol Mech Methods 2021; 31:631-643. [PMID: 34219611 DOI: 10.1080/15376516.2021.1950248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aluminum phosphide (AlP) causes serious poisoning in which severe cardiac suppression is the significant lethal consequence. According to evidence, levosimendan can exert outstanding cardiac support and protection in different pathological conditions. This study aimed to investigate the mechanisms by which levosimendan may alleviate cardiovascular toxicity due to AlP intoxication in the rat model. The groups included control group (normal saline only), sole levosimendan groups (12, 24, 48 μg/kg), AlP group (10 mg/kg), and AlP + levosimendan groups receiving 12, 24, 48 μg/kg levosimendan intraperitoneally 30 min after AlP administration. Electrocardiographic (ECG) parameters (QRS and PR duration and ST height), heart rate, and blood pressure were monitored for 180 minutes. Also, after 24 h of poisoning, echocardiography was applied to assess left ventricle function. Evaluation of the biochemical parameters in heart tissue, including mitochondrial complexes I, II, IV activity, ADP/ATP ratio, the rate of apoptosis, malondialdehyde (MDA), lactate, and troponin I levels, were done after 12 and 24 h. AlP-induced ECG abnormalities (PR duration and ST height), reduction in heart rate, blood pressure, cardiac output, ejection fraction, and stroke volume were improved by levosimendan administration. Besides, levosimendan significantly improved complex IV activity, the ADP/ATP ratio, apoptosis, MDA, lactate, and troponin I level following AlP-poisoning. Our results suggest that levosimendan might alleviate AlP-induced cardiotoxicity by modulating mitochondrial activity and improving cardiac function. However, the potential clinical use of levosimendan in this toxicity needs more investigations.
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Affiliation(s)
- Maryam Armandeh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Bameri
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Baeeri
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Haghi-Aminjan
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahban Rahimifard
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Shokoufeh Hassani
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Hooshangi Shayesteh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Madiha Khalid
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahedeh Samadi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rohollah Hosseini
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Masoudi Fard
- Department of Surgery & Radiology, Faculty of Veterinary Medicine, Tehran University, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (P SRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Hosseini SF, Forouzesh M, Maleknia M, Valiyari S, Maniati M, Samimi A. The Molecular Mechanism of Aluminum Phosphide poisoning in Cardiovascular Disease: Pathophysiology and Diagnostic Approach. Cardiovasc Toxicol 2021; 20:454-461. [PMID: 32712815 DOI: 10.1007/s12012-020-09592-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Nowadays, poisoning with metal phosphides, especially aluminum phosphide (ALP), is one of the main health threats in human societies. Patients suffer from significant complications due to this type of poisoning, and the heart is one of the main organs targeted by ALP. Therefore, in this study, we discussed the effect of phosphine on cardiac function. This study is based on data obtained from PubMed, between 2002 and 2020. The key keywords included "Aluminum phosphide," "Oxidative Stress," "Mitochondria," "Cardiovascular disease," and "Treatment." The results showed that ALP produced reactive oxygen species (ROS) due to mitochondrial dysfunction. ROS production leads to red blood cell hemolysis, decreased ATP production, and induction of apoptosis in cardiomyocytes, which eventually results in cardiovascular disease. Since ALP has the most significant effect on cardiomyocytes, the use of appropriate treatment strategies to restore cell function can increase patients' survival.
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Affiliation(s)
| | - Mehdi Forouzesh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Mohsen Maleknia
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samira Valiyari
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Mahmood Maniati
- Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
| | - Azin Samimi
- Legal Medicine Research Center, Legal Medicine Organization, Ahvaz, Iran. .,Department of Toxicology, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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26
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Barary M, Pirzadeh M, Rezaeian N, Dadashnia M, Mohammadi-Daniali S, Pahlavani F, Manouchehri A, Kazemi S, Moghadamnia A. An epidemiological study of poisoning cases in Babol (northern Iran) from 2015 to 2018. Caspian J Intern Med 2021; 12:35-44. [PMID: 33680396 PMCID: PMC7919171 DOI: 10.22088/cjim.12.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND Poisoning is a major public health problem that constitutes a significant share of the global burden of disease. Previous studies conducted in this area indicated the importance of such epidemiological studies. The most critical impact of these studies is their effect on changing current regulations and, therefore, decreasing poisoning cases. We aimed to evaluate all poisoning cases with regard to the patients' demographics and the involved intoxicants. METHODS The present study was conducted to investigate all poisoning cases who were admitted during a three-year period. Causes of poisoning, hospitalization, management procedures and outcome of the cases were surveyed. A total of 1448 patients referred to Shahid Beheshti Hospital (Babol, Iran) from 2015 to 2018. RESULTS More than half of the patients were females (51.7%), and the majority of poisoning cases were seen in patients aged between 15 to 25 years (34.2%). It was found that suicide made a large part of poisoning cases (65.6%), and females tend to attempt suicide more than males (64.3% vs. 35.7%, respectively). Also, regular drugs followed by club drugs were the most abundant toxic agents (52.1% and 23.3%, respectively). Aluminum phosphide (AlP) was the most lethal intoxicant in our study, accounting for 68.2% of all deaths. CONCLUSION According to the results, it is concluded that the existing regulations for drug control and suicide prevention have not been efficient enough and further actions yet to be made to reduce the consequences of drug- and non-drug-related toxicities.
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Affiliation(s)
- Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Marzieh Pirzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Nastaran Rezaeian
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mahsa Dadashnia
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | | | - Fatemeh Pahlavani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Aliasghar Manouchehri
- Department of Internal Medicine, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Aliakbar Moghadamnia
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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27
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Abstract
Incorporating the toxidrome-specific prognostic systems into the daily emergency department practice might become a standard of care in low- and middle-income countries. The PGI score is appealing because it is quick and easy, it accurately identifies high-risk patients at in-hospital mortality, and it shows promise in predicting those at low risk. Although further validation of the PGI score is required in more extensive studies, it can help direct appropriate resources to those most likely to benefit and stratify patients for testing novel clinical interventions. How to cite this article: Pannu AK, Bhalla A. A Simple Tool Predicts Mortality in Aluminum Phosphide Self-poisoning. Indian J Crit Care Med 2020;24(9):755-756.
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Affiliation(s)
- Ashok K Pannu
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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28
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Jahedsani A, Khezri S, Ahangari M, Bakhshii S, Salimi A. Apigenin attenuates Aluminum phosphide-induced cytotoxicity via reducing mitochondrial/Lysosomal damages and oxidative stress in rat Cardiomyocytes. Pestic Biochem Physiol 2020; 167:104585. [PMID: 32527440 DOI: 10.1016/j.pestbp.2020.104585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/03/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
Apigenin, is a natural compound that found in high amounts in vegetables and fruits. This natural flavone has shown strong cardioprotective effects in animal and clinical studies. Due to cardioprotective effects of apigenin in previous studies, we hypothesized that apigenin protects isolated cardiomyocytes from aluminum phosphide(AlP)-induced toxicity as the most common disturbances after exposure with this agent. By using of biochemical and flowcytometry techniques; cell viability, reactive oxygen species (ROS) generation, mitochondria membrane potential (MMP), lysosomal membrane integrity, malondialdehyde (MDA) and oxidized/reduced glutathione (GSH/GSSG) content were measured in rat heart isolated cardiomyocytes. Our results showed that the administration of apigenin (5-100 μM) efficiently decreased (P < .05) cytotoxicity, oxidative, lysosomal and mitochondrial damages induced by AlP (20 μg/ml) in isolated cardiomyocytes. Taken together, apigenin protected the cardiomyocytes against AlP toxicity via the protection of mitochondria and lysosome mediated by its antioxidant properties.
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Affiliation(s)
- Asal Jahedsani
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saleh Khezri
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran; Students Research Committee, Faculty of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahsa Ahangari
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saba Bakhshii
- 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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29
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Mehrpour O, Asadi S, Yaghoubi MA, Azdaki N, Mahmoodabadi N, Javadmoosavi S. Cardiogenic Shock Due to Aluminum Phosphide Poisoning Treated with Intra-aortic Balloon Pump: A Report of Two Cases. Cardiovasc Toxicol 2020; 19:474-481. [PMID: 30949845 DOI: 10.1007/s12012-019-09513-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The mortality rate from aluminum phosphide (AlP) poisoning is as high as 70-100%, with refractory hypotension and severe metabolic acidosis being the two most common presentations in this poisoning. As this poisoning has no specific antidote, treatments revolve around supportive care. Cardiogenic shock created by toxic myocarditis is considered the main cause of mortality in these patients. Meanwhile, the intra-aortic balloon pump (IABP) has been suggested for the treatment of cardiogenic shock. This article reports the successful treatment of cardiogenic shock caused by AlP poisoning in a 17-year-old man and a 21-year-old woman using the IABP procedure.
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Affiliation(s)
- Omid Mehrpour
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA.
| | - Sadegh Asadi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand, 9717853577, Iran
| | - Mohammad Ali Yaghoubi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Azdaki
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Nastaran Mahmoodabadi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand, 9717853577, Iran
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30
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Rao CC, Himaaldev GJ. STEMI in Young Befogged by Aluminum Phosphide Toxicity-Role of ECMO as Salvage Therapy and Trimetazidine and Magnesium to Suppress Arrhythmias. Indian J Crit Care Med 2020; 24:727-730. [PMID: 33024386 PMCID: PMC7519610 DOI: 10.5005/jp-journals-10071-23533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Aluminum phosphide poisoning (ALP) has a high-mortality rate despite intensive care management, primarily because it causes severe myocardial depression. This case report highlights the subset of ALP patients presenting as ST elevation myocardial infarction (STEMI) with profound myocardial dysfunction and multiorgan failure and successfully treated with extracorporeal membrane oxygenation (ECMO), trimetazidine, and magnesium. Case description A 25-year-old man without any comorbidities was brought to emergency department with dyspnea and hypotension. His electrocardiograph (ECG) revealed STEMI with elevated troponin levels, arterial blood gas (ABG) showed severe metabolic acidosis, and echocardiography (echo) revealed ejection fraction 15%. He was initiated on venoarterial (VA) ECMO in view of refractory hypotension. History of consumption of three tabs of celphos was revealed later by the family members. He progressed to cardiogenic shock, arrhythmias, respiratory failure, acute kidney injury with severe lactic acidosis, liver injury, pancreatitis, and disseminated intravascular coagulation (DIC). He was successfully supported by ECMO, hemodialysis, magnesium, trimetazidine, N-acetyl cysteine, inotropes, and blood products. He was weaned off ECMO on day 6 and was discharged home on day 12. Despite his severe and confounding clinical presentation, he had complete normalization of end-organ dysfunction with no neurological sequela. This case demonstrates the high index of suspicion required for ALP, given the potential for rapid progression and severe multiorgan toxicity. This report also highlights the importance of early referral to a tertiary care center with ECMO capability and also the role of magnesium and trimetazidine to suppress arrhythmias. Conclusion Aluminum phosphide poisoning can present as STEMI with cardiogenic shock resulting in acute kidney injury, liver injury, pancreatitis, and DIC. Venoarterial ECMO provides an effective means of support until the recovery of organ function. Trimetazidine and magnesium are helpful in suppressing fatal arrhythmias. This report emphasizes that early recognition and early institution of ECMO can save many young lives who succumb to toxic effects of this poison. How to cite this article Rao CC, Himaaldev GJ. STEMI in Young Befogged by Aluminum Phosphide Toxicity—Role of ECMO as Salvage Therapy and Trimetazidine and Magnesium to Suppress Arrhythmias. Indian J Crit Care Med 2020;24(8):727–730.
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Affiliation(s)
- Chaitra C Rao
- Department of Intensive Care, Apollo Hospitals, Bengaluru, Karnataka, India
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Abstract
Introduction Aluminum phosphide (AlP) ingestion for self-harm is associated with a high case-fatality rate (CFR) in low- and middle-income countries. A reliable and accurate prognostic scoring tool is required for appropriate triaging, to guide clinical decision-making, and to evaluate the efficacy of therapeutic interventions for the patients with AlP toxicity. Materials and methods We performed a prospective cohort study in a tertiary care hospital in north India in patients aged 15 years and over with acute AlP poisoning, investigating the parameters associated with CFR, and developing a reliable and simple prediction score. Results The CFR was 51% in this cohort of 105 patients. Three parameters—pH <7.25, score on Glasgow coma scale (GCS) <13, and systolic blood pressure (SBP) <87 mm Hg were most robust predictors of CFR (odds ratio; 12.614, 18.621, and 17.600, respectively; area under the receiver operating characteristic curve—0.808, 0.796, and 0.776, respectively). Based on these parameters (with 1 point to each), a prognostic score was developed, ranging from 0 to 3 points. A total score of 3 had a 98.2% specificity and a positive predictive value of 96.4%, whereas a score ≤1 had a 100% sensitivity and 100% negative predictive value. Conclusion A scoring system based on low pH (P), low GCS score (G), and impaired or low SBP (I) (“PGI” score) may provide a simplified predictive model for mortality in AlP poisoning. How to cite this article Pannu AK, Bhalla A, Sharma A, Sharma N. “PGI Score”: A Simplified Three-point Prognostic Score for Acute Aluminum Phosphide Poisoning. Indian J Crit Care Med 2020;24(9):790–793.
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Affiliation(s)
- Ashok K Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lu MF, Nie SN. [Progress in treatment of acute aluminum phosphide poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2019; 37:877-880. [PMID: 31838827 DOI: 10.3760/cma.j.issn.1001-9391.2019.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aluminum phosphide (ALP) is frequently used for grain conservation despite its high toxicity. In some developing countries increased utilization of ALP has resulted in increment of ALP-attributed poisoning numbers. The mortality of ALP poisoning is extremely high and no effective antidote is available so far. However, the astute survey of potential misconceptions in the course of acute toxicity has led some scientists to introduce novel therapeutic approaches. Meanwhile, some new antioxidants were discovered and expected to be used in the management of ALP poisoning. In addition, the progress in intensive care has promoted technologies such as CRRT, IABP and ECMO for the treatment of ALP poisoning with reported success in alleviating severe toxicity. Recent studies on the therapy of ALP poisoning are reviewed in this article.
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Affiliation(s)
- M F Lu
- Department of Emergency Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, China; Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225000, China
| | - S N Nie
- Department of Emergency Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, China
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Shafahi A, Mostafazadeh B, Dadpour B. Inhalational Toxicity of Aluminum Phosphide as an Ongoing Concern; a Report of Two Cases. Arch Acad Emerg Med 2019; 7:e69. [PMID: 32021980 PMCID: PMC6942919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Acute aluminium phosphide (ALP) poisoning is an extremely lethal poisoning. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. Unfortunately, the absence of a specific antidote results in very high mortality and the key to successful treatment is in rapid decontamination and institution of resuscitative measures. Phosphine gas is highly toxic, and fatality is expected even several hours after continuous exposure. However, intensive supportive treatments may be lifesaving in some cases. Here, two cases of accidental inhalation intoxication with ALP are reported. One patient was discharged and another suffered cardiac arrest during treatment.
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Affiliation(s)
- Azam Shafahi
- Medical Toxicology Research Center, Faculty ofMedicine,Mashhad University ofMedical Sciences,Mashhad, Iran
| | - Babak Mostafazadeh
- Toxicological Research Center, Shahid Beheshti University ofMedical Sciences, Tehran, Iran.,Department of ForensicMedicine and Toxicology, Shahid Beheshti University ofMedical Sciences, Tehran, Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, Faculty ofMedicine,Mashhad University ofMedical Sciences,Mashhad, Iran.,Corresponding author: Bita Dadpour; Department of Clinical Toxicology, Imam Reza Hospital, Mashhad, Iran. Postal Code: 9138813944
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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. Environ Sci Pollut Res Int 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Omid Mehrpour
- a Rocky Mountain Poison and Drug Safety, Denver Health , Denver , CO , USA
| | - Natalie Neumann
- a Rocky Mountain Poison and Drug Safety, Denver Health , Denver , CO , USA
| | - Patrick Ng
- a Rocky Mountain Poison and Drug Safety, Denver Health , Denver , CO , USA
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Baldwin RA, Stetson DI, Lopez MG, Engeman RM. An assessment of vegetation management practices and burrow fumigation with aluminum phosphide as tools for managing voles within perennial crop fields in California, USA. Environ Sci Pollut Res Int 2019; 26:18434-18439. [PMID: 31049861 DOI: 10.1007/s11356-019-05235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/24/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
Voles (Cricetidae) cause extensive damage to a variety of crops throughout much of the Northern Hemisphere. The removal of vegetation from crop fields at the end of the growing season, combined with a subsequent burrow fumigant application of aluminum phosphide, has the potential to substantially curtail vole activity but has not been thoroughly examined. We set up a study to test the impact of these management tools in perennial globe artichoke (Cynara cardunculus var. scolymus) fields in Monterey County, CA, during 2010 and 2011, to determine their potential utility as part of an integrated pest management (IPM) program for managing California voles (Microtus californicus). We used both chewing indices and mortality estimates derived via radiotelemetry to assess the efficacy of aboveground vegetation removal and aluminum phosphide applications on vole abundance. We determined the impact of plowing artichoke fields on vole activity as well. Both removal of vegetation and applications of aluminum phosphide substantially reduced vole presence within treated fields. Plowing also reduced vole abundance to the point of little residual activity following treatment. These management practices appear to be effective at eliminating voles from crop fields. Combining these tools with management practices designed to slow down reinvasion by neighboring vole populations (e.g., barriers, repellents, traps) has the potential to substantially reduce farmer reliance on rodenticides for vole management, although rodenticides will still be needed to curtail populations that reestablish within crop fields. Such an IPM approach should substantially benefit both farmers and agro-ecosystems.
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Affiliation(s)
- Roger A Baldwin
- Department of Wildlife, Fish, and Conservation Biology, One Shields Avenue, University of California, Davis, CA, 95616, USA.
| | - Denise I Stetson
- Kearney Agricultural Research and Extension Center, University of California, 9240 South Riverbend Avenue, Parlier, CA, 93648, USA
- National Ecological Observatory Network, Pacific Northwest, 1211 SE Cardinal Court, Vancouver, WA, 98683, USA
| | - Manuel G Lopez
- Kearney Agricultural Research and Extension Center, University of California, 9240 South Riverbend Avenue, Parlier, CA, 93648, USA
- California Department of Fish and Wildlife, 1700 9th Street, Sacramento, CA, 95811, USA
| | - Richard M Engeman
- USDA/Wildlife Services, National Wildlife Research Center, 4101 LaPorte Avenue, Fort Collins, CO, 80521, USA
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Abstract
Hemolysis associated with aluminum phosphide poisoning is very rare. Intravascular hemolysis in presence of glucose-6-phosphate dehydrogenase (G6PD) deficiency has been reported rarely in literature. We are reporting a case of young male patient with history of aluminum phosphide poisoning and complicated with intravascular hemolysis without G6PD deficiency. It has been reported only once in the literature.
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Affiliation(s)
- Sayan Malakar
- Department of Medicine, Dr RPGMC, Tanda, Kangra, HP, India
| | | | - Katyayani Dutt
- Department of Medicine, Dr RPGMC, Tanda, Kangra, HP, India
| | - Sujeet Raina
- Department of Medicine, Dr RPGMC, Tanda, Kangra, HP, India
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Haghi-Aminjan H, Baeeri M, Rahimifard M, Alizadeh A, Hodjat M, Hassani S, Asghari MH, Abdollahi A, Didari T, Hosseini R, Sharifzadeh M, Abdollahi M. The role of minocycline in alleviating aluminum phosphide-induced cardiac hemodynamic and renal toxicity. Environ Toxicol Pharmacol 2018; 64:26-40. [PMID: 30290328 DOI: 10.1016/j.etap.2018.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/28/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
Poisoning with aluminum phosphide (AlP) has been attributed to the high rate of mortality among many Asian countries. It affects several organs, mainly heart and kidney. Numerous literature demonstrated the valuable effect of minocycline in mitigating pathological symptoms of heart and kidney disease. The aim of the present study was to evaluate the probable protective effect of minocycline on cardiac hemodynamic parameters abnormalities and renal toxicity induced by AlP-poisoning in the rat model. AlP was administered by gavage at 12 mg/kg body weight followed by injection of minocycline for two interval times of 12 and 24 h, at 40, 80, 120 mg/kg body weight. Electrocardiographic (ECG) parameters were monitored, 30 min after AlP gavage for 6 h using an electronic cardiovascular monitoring device. Kidney tissue and serum were collected for the study of histology, mitochondrial complexes I, II, IV, lactate dehydrogenase (LDH) and myeloperoxidase (MPO) activity, ADP/ATP ratio, mitochondrial cytochrome c release, apoptosis, lactate, BUN, and Cr levels. The results demonstrated that AlP induces ECG abnormalities, and failure of heart rate and blood pressure, which improved significantly by minocycline. Minocycline treatment significantly improved complexes I, IV, MPO and LDH activities, and also reduced the ADP/ATP ratio, lactate level, release of cytochrome c, and apoptosis in the kidney following AlP-poisoning. Also, the histological results showed an improvement of kidney injury in minocycline treated groups. In conclusion, the findings of this study showed that minocycline could improve cardiac hemodynamic abnormalities and kidney injury following AlP-poisoning, suggesting minocycline might be a possible candidate for the treatment of AlP-poisoning.
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Affiliation(s)
- Hamed Haghi-Aminjan
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Baeeri
- Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahban Rahimifard
- Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mahshid Hodjat
- Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran; Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shokoufeh Hassani
- Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Asghari
- Department of Pharmacology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Alireza Abdollahi
- Department of Pathology, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Tina Didari
- Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Rohollah Hosseini
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sharifzadeh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.
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Karimani A, Mohammadpour AH, Zirak MR, Rezaee R, Megarbane B, Tsatsakis A, Karimi G. Antidotes for aluminum phosphide poisoning - An update. Toxicol Rep 2018; 5:1053-1059. [PMID: 30406022 PMCID: PMC6214862 DOI: 10.1016/j.toxrep.2018.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023] Open
Abstract
Aluminum phosphide (AlP), an inexpensive solid fumigant, is frequently used for grain conservation despite its alleged high toxicity. Increased utilization of AlP for agricultural and non-agricultural purposes during the last four decades has resulted in increment of AlP-attributed poisoning numbers. Moreover, due to its limitless accessibility in developing countries, AlP has been increasingly used for suicide. Moisture-exposed AlP undergoes a chemical reaction producing phosphine gas, which in turn inhibits cytochrome oxidase and impedes cellular oxygen consumption. Lethality remains elevated reaching rates of >50% and no effective antidote is available. Nevertheless, experimental and clinical studies suggested that magnesium sulfate, melatonin, N-acetylcysteine, glutathione, sodium selenite, vitamin C and E, triiodothyronine, liothyronine, vasopressin, milrinone, Laurus nobilis L., 6-aminonicotinamide, boric acid, acetyl-L-carnitine and coconut oil, may serve as antidotes by reducing the deleterious oxidative properties of AlP. This article reviews the afore-mentioned chemicals suggested to specifically treat AlP poisoning and discusses their protective mechanisms and main outcomes.
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Affiliation(s)
- Asieh Karimani
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Zirak
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Gholamreza Karimi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
Aluminum phosphide (ALP) poisoning is one of the fatal poisonings in the world. Hemolysis is a rare presentation of this poisoning. Here, we report an episode of hemolysis due to G6PD deficiency after ingestion of ALP and also the patient survived.
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Affiliation(s)
- Ali Akbar Vosooghi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrzad Salmasi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Navabi SM, Navabi J, Aghaei A, Shaahmadi Z, Heydari R. Mortality from aluminum phosphide poisoning in Kermanshah Province, Iran: characteristics and predictive factors. Epidemiol Health 2018; 40:e2018022. [PMID: 29807406 PMCID: PMC6060335 DOI: 10.4178/epih.e2018022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/27/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Aluminum phosphide (ALP), also known in Iran as rice tablets, is one of the most effective rodenticides used to protect stored grain. However, ALP poisoning regularly causes mortality in humans. The aim of this study was to evaluate the characteristics and predictive factors of mortality from ALP poisoning. METHODS This study evaluated all patients with ALP poisoning referred to Imam Khomeini Hospital in Kermanshah Province, Iran from 2014 to 2015. For each patient, the following information was recorded: age, sex, the number of tablets consumed, the number of suicide attempts, the time elapsed from consumption to treatment, blood pressure, blood pH, HCO3 levels, and PCO2 . Differences between the survivors and non-survivors of ALP poisoning were analyzed using univariate logistic regression and multivariate analysis. RESULTS In this study, 48 patients were male and 29 patients were female (total: 77 patients). The average age of the survivors and non-survivors was 28.7 and 31.3 years, respectively. All cases (100%) of ALP poisoning were intentional, with the goal of committing suicide. The main predictive variables of mortality from ALP poisoning were blood pressure, blood pH, and time elapsed from consumption to treatment. CONCLUSIONS The likelihood of mortality in patients with ALP poisoning can be predicted using blood pressure, blood pH, and time elapsed from consumption to treatment. These findings may help healthcare providers take more effective measures to treat patients with ALP poisoning.
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Affiliation(s)
| | - Jafar Navabi
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abbas Aghaei
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Shaahmadi
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ruhollah Heydari
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Abstract
Context: Aluminum phosphide (ALP) is a highly toxic agricultural fumigant pesticide commonly implicated in poisoning. Aim: The aim of the study was to study the profile of patients presenting with ALP poisoning in Dr. RPGMC Kangra, Tanda, Himachal Pradesh. Settings and Design: This was a retrospective study conducted in the Department of Medicine at Dr. RPGMC Kangra, Tanda, Himachal Pradesh, from August 2011 to January 2014. Material and Methods: Case record forms of 117 patients were reviewed and analyzed. Data were collected for sociodemographic and clinical parameters. Outcome of patients was recorded as expired and improved. All the patients were managed symptomatically. Statistical Analysis: Statistical analysis was performed using SPSS version 15. P < 0.05 was considered statistically significant. Results: Out of the total 117 patients included in the study, 61 (52.1%) were males and 56 (47.1%) were females. Mean age ± standard deviation of presentation was 30.9 ± 12.2 years. About 70% of the patients were from rural background. Out of the total 117 patients, 68 (58.1%) patients had expired and 49 (41.9%) had improved. Most of the patients in the expired group consumed ALP in tablet form (54.7% of the total). Nearly 57% of the patients had leukocytosis at presentation and <5% had leukopenia. The mean pulse rate and mean systolic blood pressure in the expired group were 116.24 ± 14.3 per minute and 89.9 ± 16.83 mmHg which was statistically significant. The mean change in creatinine value (ΔCr) in the expired group was 1.03 ± 0.36 which was statistically significant. Conclusions: The prognosis of the patients can be anticipated on assessing the cardiac status and mean change in creatinine value (ΔCr) at the time of admission.
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Affiliation(s)
- Tarun Sharma
- Department of Medicine, Dr. RPGMC Kangra, Tanda, Himachal Pradesh, India
| | - Aradhna Sharma
- Department of Pharmacology, Dr. RPGMC Kangra, Tanda, Himachal Pradesh, India
| | - Dheeraj Kapoor
- Department of Medicine, Dr. RPGMC Kangra, Tanda, Himachal Pradesh, India
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Salimi A, Paeezi M, Yousefsani BS, Shadnia S, Hassanian-Moghaddam H, Zamani N, Pourahmad J. Inhibition of glucose-6-phosphate dehydrogenase protects hepatocytes from aluminum phosphide-induced toxicity. Pestic Biochem Physiol 2017; 143:141-146. [PMID: 29183584 DOI: 10.1016/j.pestbp.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 06/07/2023]
Abstract
Aluminum phosphide (AlP) poisoning is a severe toxicity with 30-70% mortality rate. However, several case reports presented AlP-poisoned patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency and extensive hemolysis who survived the toxicity. This brought to our mind that maybe G6PD deficiency could protect the patients from severe fatal poisoning by this pesticide. In this research, we investigated the protective effect of 6-aminonicotinamide (6-AN)- as a well-established inhibitor of the NADP+- dependent enzyme 6-phosphogluconate dehydrogenase- on isolated rat hepatocytes in AlP poisoning. Hepatocytes were isolated by collagenase perfusion method and incubated into three different flasks: control, AlP, and 6-AN+ALP. Cellar parameters such as cell viability, reactive oxygen species (ROS) formation, mitochondria membrane potential collapse (MMP), lysosomal integrity, content of reduced (GSH) and oxidized glutathione (GSSG) and lipid peroxidation were assayed at intervals. All analyzed cellular parameters significantly decreased in the third group (6-AN+AlP) compared to the second group (AlP), showing the fact that G6PD deficiency induced by 6-AN had a significant protective effect on the hepatocytes. It was concluded that G6PD deficiency significantly reduced the hepatotoxicity of AlP. Future drugs with the power to induce such deficiency may be promising in treatment of AlP poisoning.
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Affiliation(s)
- Ahmad Salimi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Science, Ardabil, Iran
| | - Maryam Paeezi
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Sadat Yousefsani
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Pharmacology and Toxicology, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Shahin Shadnia
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Jalal Pourahmad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Halvaei Z, Tehrani H, Soltaninejad K, Abdollahi M, Shadnia S. Vitamin E as a novel therapy in the treatment of acute aluminum phosphide poisoning. Turk J Med Sci 2017; 47:795-800. [PMID: 28618724 DOI: 10.3906/sag-1512-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/22/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Aluminum phosphide (AlP) is commonly used as a fumigant in developing countries. Induction of oxidative stress is one of the most important mechanisms of its toxicity. In this regard, and considering that there is no specific antidote for its treatment, the aim of this study was to evaluate the effect of vitamin E in the treatment of acute AlP poisoning. MATERIALS AND METHODS This was a clinical trial on acute AlP poisoned patients. All patients received supportive treatment. In addition, the treatment group received vitamin E (400 mg/BD/IM). Level of malondialdehyde (MDA) and total antioxidant capacity of plasma were measured. RESULTS There was no significant difference between the treatment and control groups with regard to demographic, clinical, or paraclinical data or Simplified Acute Physiology Score II (SAPSII) on admission. Systolic blood pressure significantly increased during the first 24 h in the treatment group (P < 0.05). The plasma MDA level significantly decreased in the treatment group (P < 0.05). Vitamin E administration decreased the necessity (30% vs. 62%, P < 0.05) and duration of intubation and mechanical ventilation (P < 0.05). It significantly reduced the mortality rate in the treatment group compared to the control group (15% vs. 50%, respectively, P < 0.05). CONCLUSION Vitamin E along with supportive treatment could have a therapeutic effect in acute AlP poisoning.
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Affiliation(s)
- Zahra Halvaei
- Faculty of Pharmacy, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Hiva Tehrani
- Faculty of Pharmacy, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Kambiz Soltaninejad
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmaceutical, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Toxicological and Diseases Group, Pharmaceutical Sciences Research Group, Tehran Unviversity of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Toxicological Research Center, Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital Poison Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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45
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Asghari MH, Moloudizargari M, Baeeri M, Baghaei A, Rahimifard M, Solgi R, Jafari A, Aminjan HH, Hassani S, Moghadamnia AA, Ostad SN, Abdollahi M. On the mechanisms of melatonin in protection of aluminum phosphide cardiotoxicity. Arch Toxicol 2017; 91:3109-3120. [PMID: 28551710 DOI: 10.1007/s00204-017-1998-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022]
Abstract
Aluminum phosphide (AlP), one of the most commonly used pesticides worldwide, has been the leading cause of self-poisoning mortalities among many Asian countries. The heart is the main organ affected in AlP poisoning. Melatonin has been previously shown to be beneficial in reversing toxic changes in the heart. The present study reveals evidence on the probable protective effects of melatonin on AlP-induced cardiotoxicity in rats. The study groups included a control (almond oil only), ethanol 5% (solvent), sole melatonin (50 mg/kg), AlP (16.7 mg/kg), and 4 AlP + melatonin groups which received 20, 30, 40 and 50 mg/kg of melatonin by intraperitoneal injections following AlP treatment. An electronic cardiovascular monitoring device was used to record the electrocardiographic (ECG) parameters. Heart tissues were studied in terms of oxidative stress biomarkers, mitochondrial complexes activities, ADP/ATP ratio and apoptosis. Abnormal ECG records as well as declined heart rate and blood pressure were found to be related to AlP administration. Based on the results, melatonin was highly effective in controlling AlP-induced changes in the study groups. Significant improvements were observed in the activities of mitochondrial complexes, oxidative stress biomarkers, the activities of caspases 3 and 9, and ADP/ATP ratio following treatment with melatonin at doses of 40 and 50 mg/kg. Our results indicate that melatonin can counteract the AlP-induced oxidative damage in the heart. This is mainly done by maintaining the normal balance of intracellular ATP as well as the prevention of oxidative damage. Further research is warranted to evaluate the possibility of using melatonin as an antidote in AlP poisoning.
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Affiliation(s)
- Mohammad Hossein Asghari
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pharmacology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Milad Moloudizargari
- Student Research Committee, Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Baeeri
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran
| | - Amir Baghaei
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahban Rahimifard
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran
| | - Reza Solgi
- Legal Medicine Research Center, Legal Medicine Organization of Iran, Hamedan, Iran
| | - Abbas Jafari
- Department of Occupational Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamed Haghi Aminjan
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shokoufeh Hassani
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran
| | - Ali Akbar Moghadamnia
- Department of Pharmacology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Nasser Ostad
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. .,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran.
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46
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Erfantalab P, Soltaninejad K, Shadnia S, Zamani N, Hassanian-Moghaddam H, Mahdavinejad A, Damaneh BH. Trend of blood lactate level in acute aluminum phosphide poisoning. World J Emerg Med 2017; 8:116-120. [PMID: 28458755 DOI: 10.5847/wjem.j.1920-8642.2017.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aluminum phosphide (AlP) poisoning is common in the developing countries. There is no specific antidote for the treatment of acute AlP poisoning. Early diagnosis of poisoning and outcome predictors may facilitate treatment decisions. The objective of this study was to determine the trend of blood lactate level in acute AlP poisoning to evaluate its role as a prognostic factor. METHODS This was a prospective study on acute AlP intoxicated patients during one year. Demographic data, clinical and laboratory data on admission, and outcome were recorded in a self-made questionnaire. Blood lactate levels were analyzed every two hours for 24 hours. RESULTS Thirty-nine (27 male, 12 female) patients were included in the study. The mortality rate was 38.5%. The mean blood pressure, pulse rate, blood pH and serum bicarbonate level were significantly different between the survivors and non-survivors groups. Blood lactate level was significantly higher in the non-survivors group during 8 to 16 hours post ingestion. CONCLUSION Blood lactate level could be used as an index of severity of acute AlP poisoning.
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Affiliation(s)
- Peyman Erfantalab
- Toxicological Research Center, Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kambiz Soltaninejad
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Shahin Shadnia
- Toxicological Research Center, Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Toxicological Research Center, Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Toxicological Research Center, Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezou Mahdavinejad
- Toxicological Research Center, Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Hashemi Damaneh
- Toxicological Research Center, Excellent Center of Clinical Toxicology, Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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47
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Abstract
Background: N-acetyl cysteine (NAC) is a powerful antioxidant and has been used extensively in the treatment of paracetamol overdose with great success. Aluminum phosphide (ALP) ingestion results in significant oxidative stress. In this study, we evaluated the effects of NAC on mortality in patients with severe ALP poisoning. Subjects and Methods: This prospective intervention study was carried out in the emergency medical unit attached to the Nehru Hospital at PGIMER, Chandigarh, over a period of 1 year. All the patients presenting with severe ALP poisoning were randomized into two group. The treatment group received NAC in the dose of 150 mg/kg intravenous over 1 h, followed by 50 mg/kg over 4 h, followed by 100 mg/kg 16 h in 5% dextrose. The placebo group received 5% dextrose. The primary end point was mortality. Results: A total of 50 patients were recruited. The baseline parameters were comparable in both groups. The survivors in the treatment group received 19 g of NAC, but the nonsurvivors received only 12.15 g of NAC. The overall mortality in the study group was 88% with 87.5% mortality in the treatment group and 88.5% in the placebo group. Conclusions: Antioxidant therapy in the form of NAC in severe ALP poisoning did not confer any survival benefit.
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Affiliation(s)
- Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Jyothinath
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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48
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Taghaddosinejad F, Farzaneh E, Ghazanfari-Nasrabad M, Eizadi-Mood N, Hajihosseini M, Mehrpour O. The effect of N-acetyl cysteine (NAC) on aluminum phosphide poisoning inducing cardiovascular toxicity: a case-control study. Springerplus 2016; 5:1948. [PMID: 27917341 PMCID: PMC5102994 DOI: 10.1186/s40064-016-3630-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/01/2016] [Indexed: 12/02/2022]
Abstract
Background
Aluminum phosphide (AlP) is a very effective indoor and outdoor pesticide. We investigated the effects of N-acetyl cysteine (NAC) on the survival time, hemodynamics, and cardiac biochemical parameters at various time intervals in some cases of AlP poisoning. Methods This research was a case–control study to evaluate 63 AlP poisoned patients during 2010–2012. Patients with cardiovascular complications of AlP to be treated with intravenous NAC plus conventional treatment were considered as the case group and compared with patients who did not receive NAC. NAC infusion was administered to the case group at 300 mg/kg for 20 h. The data gathered included age, sex, heart rate, Systolic blood pressure (SBP), creatine phosphokinase (CPK), creatine kinase MB (CK-MB), and ECG at the admission time and 12, 18, and 24 h after admission. Analysis of repeated measures was performed to check the variability of parameters over time. Results The mean ages in the case and control groups were 26.65 ± 1.06 (19–37 years) and 28.39 ± 1.11 (18–37 years), respectively (P = 0.266). Most of the patients were female (56.5%). CK-MB means were significantly different between the two groups, but no differences between the other variables were observed. Also, CK-MB, CPK, heart rate, and systolic blood pressure means became significantly different over time (0, 12, 18, and 24 h) in both groups (P < 0.001). NAC prevented sharp heart rate fluctuations in AlP patients in the case group. Regarding the outcomes, 17 patients died (10 patients in the control and 7 patients in the case groups). No side-effects of NAC were observed. Conclusion Our patients could be managed by the positive role of NAC as the biochemical index of cardiotoxicity was found to elevate in both the case and control groups. Therefore, for the management protocol optimization, NAC evaluation should be done in further cases.
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Affiliation(s)
| | - Esmaeil Farzaneh
- Department of Forensic Medicine and Toxicology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahdi Ghazanfari-Nasrabad
- Legal Medicine Research Center, Legal Medicine Organization, Bahar Cross, Taleghani Avenue, Tehran, 1114795113 Iran
| | - Nastaran Eizadi-Mood
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Hajihosseini
- Birjand CardioVascular Diseases Research Center, Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138 Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138 Iran
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49
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Abstract
Aluminum phosphide (ALP) is a cheap, easily available agricultural pesticide which causes lethal poisoning by liberation of phosphine and inhibition of cytochrome c oxidase thereby leading to cellular hypoxia. Although there is no known specific antidote, clinical trials are still going on. We present here two cases of ALP poisoning who were successfully managed by treatment with lipid emulsion and intravenous magnesium sulfate.
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Affiliation(s)
- Udismita Baruah
- Department of Anaesthesia and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Ameeta Sahni
- Department of Anaesthesia and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Harish C Sachdeva
- Department of Anaesthesia and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
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50
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Farahani MV, Soroosh D, Marashi SM. Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An Evidence-based review. Indian J Crit Care Med 2016; 20:724-730. [PMID: 28149031 PMCID: PMC5225774 DOI: 10.4103/0972-5229.195712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The majority of aluminum phosphide (ALP) toxicity cases are suicidal attempts. Despite advances in critical care medicine, the mortality rate of ALP remains very high. Unfortunately, knowledge on the toxicokinetics of ALP is very low. An obsolete idea was proposed that inhibition of complex IV of cytochrome C oxidase is responsible for multiorgan dysfunction. However, based on human studies, this effect might be insignificant. Thus, a novel idea proposes that the main mechanism might be vascular wall integrity disruption. The low frequency of acute toxicity and unanswered questions about the toxicokinetics and toxicodynamics has led to leaden advances of novel treatments. The aim of this review was to evaluate problems regarding current treatment protocols and propose new ideas based on updated information. For this purpose, we reviewed all available articles on the management of ALP poisoning published to date. Considering failure of conventional therapies on maintaining systolic blood pressure, correcting acid-base disturbances, and support cardiac function, the previous treatment protocols have been overruled. However, repudiate of conventional treatments in this deadly condition is not without penalties for the health-care provider. The introduction of new therapies including refuse of gastric lavage with water-soluble compounds, administration of a high molecular weight colloidal solution for fluid resuscitation and termination using sodium bicarbonate, and vasoactive agents has been prospected to improve patient survival. This protocol is in early clinical evaluation; nevertheless, it appears to improve patient's survival; hence, future randomized trials should be performed to support their effectiveness.
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Affiliation(s)
- Maryam Vasheghani Farahani
- Department of Forensic Medicine and Clinical Toxicology, AJA Medical School, AJA University of Medical Sciences, Tehran, Iran
| | - Davood Soroosh
- Department of Forensic Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Sayed Mahdi Marashi
- Department of Forensic Medicine and Clinical Toxicology, Shiraz University of Medical Sciences, Shiraz, Iran
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