Toxicology International (Formerly Indian Journal of Toxicology)

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Incidence and Outcome of Aluminium Phosphide Poisoning Cases Admitted to the Egyptian National Poisoning Centre


Affiliations
1 Department of Pharmacology, Cairo University, Egypt
2 National Egyptian Center of Environmental and Toxicological Research (NECTR), Cairo University, Egypt
     

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Aluminium Phosphide (ALP) poisoning is one of the major causes of suicidal deaths. It is one of the fatal pesticides. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. It causes cellular hypoxia, inhibition of cytochrome c oxidase and formation of highly reactive hydroxyl radicals. The aim of this work was to investigate ALP poisoning-related deaths in the National Egyptian Center of Environmental and Toxicological Research (NECTR), to arouse attention to its use in committing suicide due to its easy availability through the objective data from a sample of acutely poisoned patients admitted to NECTR in Cairo. Management of cases is mainly supportive as there is no specific antidote, causing high mortality rate. Early arrival and proper decontamination, resuscitation, intensive monitoring and supportive therapy may result in good outcome.

Keywords

Aluminium Phosphide (ALP), Blood Lactate Level, Mortality, Phosphine Gas, Prediction.
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  • Khosla SN, Handa R, Khosla P. Aluminium phosphide poisoning, Trop. Doct. 1992; 22(4):155−57. https://doi.org/10.1177/004947559202200404. PMid: 1440881.

  • Singh S, Singh D, Wig N, Jit I, Sharma BK. Aluminium phosphide ingestion-a clinico-pathologic study. J. Toxicol. Clin. Toxicol. 1996; 34(6):703−06. https://doi.org/10.3109/15563659609013832. PMid: 8941200.

  • Abder-Rahman HA, Battah AH, Ibraheem YM, Shomaf MS, el-Batainch N. Aluminium phosphide fatalities, new local experience, Med. Sci. Law. 2000; 40(2):164−68. https://doi.org/10.1177/002580240004000214. PMid: 10821029.

  • Wahab A, Rabbani MU, Wahab S, Khan RA. Spontaneous self-ignition in a case of acute aluminium phosphide poisoning, Am. J. Emerg. Med. 2009; 27:752−56. https:// doi.org/10.1016/j.ajem.2008.09.045. PMid: 19751640.

  • Moghadamnia AA. An update on toxicology of aluminum phosphide, DARU. J. Pharmac. Sci. 2012; 20:25. https://doi.org/10.1186/2008-2231-20-25. PMid: 23351193, PMCid: PMC3555759.

  • Moghadamnia AA, Abdollahi M. An epidemiological study of poisoning in northern Islamic Republic of Iran, East Mediterr. Hlth. J. 2002; 8(1):88−94.

  • Mehrpour O, Jafarzadeh M,Abdollahi M. A systematic review of aluminium phosphide poisoning, Arch. Ind. Hyg. Toxicol. 2012; 63(1):61−73. https://doi.org/10.2478/100041254-63-2012-2182. PMid: 22450207.

  • Hosseinian A, Pakravan N, Rafiei A,Feyzbakhsh SM. Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran, Indian J. Med. Sci. 2011; 65(4):143−50. https://doi.org/10.4103/0019-5359.104777. PMid: 23250344.

  • Chaudhary S, Momin SG, Vora DH, Modi P, Chauhan V, Chotaliya D. An epidemiological study of fatal aluminium phosphide poisoning at Rajkot, J. Pharmacy. 2013; 3(1):17−23. https://doi.org/10.9790/3013-31101723.

  • Sudakin DL. Occupational exposure to aluminium phosphide and phosphine gas? A suspected case report and review of the literature, Hum. Exp. Toxicol. 2005; 24:27−33. https://doi.org/10.1191/0960327105ht496oa. PMid: 15727053.

  • Wang W, Winther JR, Thorpe C. Erv2p: Characterization of the redox behavior of a yeast sulfhydryl oxidase, Bioch. 2007; 46:3246−54. https://doi.org/10.1021/bi602499t. PMid: 17298084, PMCid: PMC2573868.

  • Valmas N, Zuryn S, Ebert PR. Mitochondrial uncouplers act synergistically with the fumigant phosphine to disrupt mitochondrial membrane potential and cause cell death, Toxicol. 2008; 252:33−39. https://doi.org/10.1016/j.tox.2008.07.060. PMid: 18755236.

  • Almasieh M, Lieven CJ, Levin LA, Di Polo A. A cellpermeable phosphine-borane complex delays retinal ganglion cell death after axonal injury through activation of the pro-survival extracellular signal-regulated kinases 1/2 pathway, J. Neurochem. 2011; 118:1075−86. https://doi.org/10.1111/j.1471-4159.2011.07382.x. PMid: 21749374, PMCid: PMC3166386.

  • Wahab A, Zaheer MS, Wahab S, Khan RA. Acute aluminium phosphide poisoning: An update, Hong Kong J. Emerg. Med. 2008;15:152−55. https://doi.org/10.1177/102490790801500306.

  • Agarwal A, Robo R, Jain N, Gutch M, Consil S, Kumar S. Oxidative stress determined through the levels of antioxidant enzymes and the effect of N-acetylcysteine in aluminum phosphide poisoning, Indian J. Crit. Care Med. 2014; 18(10):666. https://doi.org/10.4103/09725229.142176. PMid: 25316977, PMCid: PMC4195197.

  • Hugar BS, Praveen S, Hosahally JS, Kainoor S, Shetty ARS. Gastrointestinal hemorrhage in aluminum phosphide poisoning, J. Forenssci. 2015; 60(1):261−63. https://doi.org/10.1111/1556-4029.12588. PMid: 25098904.

  • Oghabian Z, Mehrpour O. Treatment of aluminium phosphide poisoning with a combination of intravenous glucagon, digoxin and antioxidant agents, Sultan. Qaboos. Univ. Med. J. 2016; 16(3):352−55. https://doi.org/10.18295/squmj.2016.16.03.015. PMid: 27606117, PMCid: PMC4996300.

  • Mathai A, Bhanu MS. Acute aluminium phosphide poisoning: Can we predict mortality? Indian J. Anesthesia. 2010; 54(4):302. https://doi.org/10.4103/0019-5049.68372. PMid: 20882171, PMCid: PMC2943698.

  • Proudfoot AT. Aluminium and zinc phosphide poisoning, Clin. Toxicol. (Phila). 2009; 47(2):89−100. https://doi.org/10.1080/15563650802520675. PMid: 19280425.

  • Glindemann D, Eismann F, Bergmann A, Kuschk P, Stottmeister U. Phosphine by bio-corrosion of phosphiderich iron, Environ Sci. Pollut. Res. Int. 1998; 5:71−74. https://doi.org/10.1007/BF02986389. PMid: 19005813.

  • Jain RK, Gouda NB, Sharma VK, Dubey TN, Shende A, Malik R et al. Esophageal complications following aluminium phosphide ingestion: An emerging issue among survivors of poisoning, Dysphagia. 2010; 25:271−76. https:// doi.org/10.1007/s00455-009-9251-y. PMid: 19727954.

  • Mehra A, Sharma N. ECMO: A ray of hope for young suicide victims with acute aluminum phosphide poisoning and shock, Indian Heart J. 2016; 68:256−57. https://doi.org/10.1016/j.ihj.2016.02.006. PMid: 27316473, PMCid: PMC4912027.

  • Singh D, Dewan I, Pandey AN, Tyagi S. Spectrum of unnatural fatalities in the Chandigarh zone of northwest India-a 25 year autopsy study from a tertiary care hospital, J. Clin. Forens. Med. 2003; 10:145−52. https://doi.org/10.1016/S1353-1131(03)00073-7.

  • Chan YH. Biostatistics 102: Quantitative data - parametric and non-parametric Tests, Singapore Med. J. 2003a; 44(8):391−96.

  • Chan YH. Biostatistics 103: Qualitative data-tests of Independence, Singapore Med. J. 2003b; 44(10):498−503.

  • Chan YH. Biostatistics 104: Correlational analysis, Singapore Med. J. 2003c; 44(12):614−19.

  • Chugh SN, Ram S, Sharma A, Arora BB, Saini AS, Malhotra KC. Adrenocortical involvement in aluminium phosphide poisoning, Indian J. Med. Res. 1989; 90:289−94.

  • Marashi SM, Arefi M, Behnoush B, Nasrabad MG, Nasrabadi ZN. Could hydroxyethyl starch be a therapeutic option in management of acute aluminum phosphide toxicity? Med. Hypotheses. 2011; 76:596−98. https://doi.org/10.1016/j.mehy.2011.01.009. PMid: 21288649.

  • Baeeri M, Shariatpanahi M, Baghaei A, Ghasemi-Niri SF, Mohammadi H, Mohammadirad A, et al. On the benefit of magnetic magnesium nano carrier in cardiovascular toxicity of aluminum phosphide, Toxicol. Ind. Hlth. 2013; 29:126−35. https://doi.org/10.1177/0748233711425074. PMid: 22075688.

  • Marashi SM, Nasri-Nasrabadi Z. Can sodium bicarbonate really help in treating metabolic acidosis caused by aluminium phosphide poisoning? Arh. Hig. Rada. Toksikol. 2015; 66:83−84. https://doi.org/10.1515/aiht-2015-66-2637. PMid: 25816308.

  • Saif Q, Khan R, Sharma A. Aluminium phosphide induced acute kidney injury, Egypt J. Int. Med. 2015; 27:115. https:// doi.org/10.4103/1110-7782.157999.

  • Mehrpour O, Gurjar M. Cardiogenic shock: The main cause of mortality in acute aluminum phosphide poisoning, Indian J. Crit. Care Med. 2017; 21:246−47. https://doi.org/10.4103/ijccm.IJCCM_97_17. PMid: 28553054, PMCid: PMC5416798.

  • Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poisonings in Mashhad, Iran 1993-2000, J. Toxicol. Clin. Toxicol. 2004; 42(7):965−75. https://doi.org/10.1081/CLT200042550.

  • Parmar P, Rathod GB, Rathod S, Parikh A. Demographic profile of aluminium phosphide poisoning in Gandhinagar, Gujarat, Internat. Arch. Integrated Med. 2015; 2(1):76−82.

  • Shadnia S, Sasanian G, Allami P, Hosseini A, Ranjbar A, Amini-Shirazi N, et al. A retrospective 7-years study of aluminum phosphide poisoning in Tehran: Opportunities for prevention, Human. Exp. Toxicol. 2009; 28:209−13. https://doi.org/10.1177/0960327108097194. PMid: 19734272.

  • Gunnerson KJ. Clinical review: The meaning of acid-base abnormalities in the intensive care unit – epidemiology, Crit. Care. 2005; 9(5):508−16. https://doi.org/10.1186/cc3786, https://doi.org/10.1186/cc3796. PMid: 16277740, PMCid: PMC1297622.

  • Louriz M, Dendane T, Abidi K, Madani N, Abouqal R, Zeggwagh AA. Prognostic factors of acute aluminum phosphide poisoning, Indian J. Med. Sci. 2009; 63(6):227−34. https://doi.org/10.4103/0019-5359.53386. PMid: 19602756.

  • Anand R, Sharma DR, Verma D, Bhalla A, Gill KD, Singh S. Mitochondrial electron transport chain complexes, catalase and markers of oxidative stress in platelets of patients with severe aluminum phosphide poisoning, Hum. Exp. Toxicol. 2013; 32(8):807−16. https://doi.org/10.1177/0960327112468909. PMid: 23821638.

  • Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock, J. Inten. Care Med. 2005; 20(5):255−71. https://doi.org/10.1177/0885066605278644. PMid:16145217.

  • Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection, Ann. Emerg. Med. 2005; 45(5):524−28. https://doi.org/10.1016/j.annemergmed.2004.12.006. PMid: 15855951.

  • Erfantalab P, Soltaninejad K, Shadnia S, Zamani N, Hassanian- Moghaddam H, Mahdavinejad A, et al. Trend of blood lactate level in acute aluminum phosphide poisoning, World J. Emerg. Med. 2017; 8:116−20. https://doi.org/10.5847/wjem.j.1920-8642.2017.02.006. PMid: 28458755 PMCid: PMC5409231.

  • Najari F, Dadpour B, Vahabzadeh M, Alizadeh-Ghamsari A, Mousavi SR, Kial IB. Value of blood lactate and TSH in predicting length of hospitalization and outcome of poisoned patients admitted to the ICU, Pharmacophore. 2018; 9(3):7−12.

  • Sulaj Z, Drishti A, Çeko I, Gashi A, Vyshka G. Fatal aluminum phosphide poisonings in Tirana (Albania), 2009-2013, DARU J. Pharm. Sci. 2015; 23(1):1−8. https:// doi.org/10.1186/s40199-015-0090-0. PMid: 25618461, PMCid: PMC4308883.

  • Farzaneh E, Ghobadi H, Akhavanakbari G, Akbarifard M, Nakhaee S, Amirabadizadeh A, et al. Prognostic factors in acute aluminium phosphide poisoning: A risk-prediction nomogram approach, Bas. Clin. Pharmacol. Toxicol. 2018; 123(3):347−55. https://doi.org/10.1111/bcpt.13005. PMid: 29527823.

  • Gupta S, Ahlawat SK. Aluminum phosphide poisoning - A review. J. Toxicol. Clin. Toxicol. 1995; 33(1):19−24. https:// doi.org/10.3109/15563659509020211. PMid:7837309.

  • Goswami M, Bindal M, Sen P, Gupta SK, Avasthi R, Ram BK. Fat and oil inhibit phosphine release from aluminium phosphide - its clinical implication, Indian J. Exp. Biol. 1994; 32(9):647−49.

  • Shadnia S, Rahimi M, Pajoumand A, Rasouli MH, Abdollahi M. Successful treatment of acute aluminium phosphide poisoning: Possible benefit of coconut oil, Hum. Exp. Toxicol. 2005; 24(4):215−18. https://doi.org/10.1191/0960327105ht513oa. PMid: 15957538.

  • Sanaei-Zadeh H, Marashi SM. Gastric decontamination in aluminium phosphide poisoning: A case against the use of water-based solutions, Arh. Hig. Rada. Toksikol. 2016; 67:364−65. https://doi.org/10.1515/aiht-2016-67-2900.PMid: 28033095.


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  • Incidence and Outcome of Aluminium Phosphide Poisoning Cases Admitted to the Egyptian National Poisoning Centre

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Authors

Eman AM. Abdel Rashid
Department of Pharmacology, Cairo University, Egypt
Nashwa M. El Mahdy
National Egyptian Center of Environmental and Toxicological Research (NECTR), Cairo University, Egypt

Abstract


Aluminium Phosphide (ALP) poisoning is one of the major causes of suicidal deaths. It is one of the fatal pesticides. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. It causes cellular hypoxia, inhibition of cytochrome c oxidase and formation of highly reactive hydroxyl radicals. The aim of this work was to investigate ALP poisoning-related deaths in the National Egyptian Center of Environmental and Toxicological Research (NECTR), to arouse attention to its use in committing suicide due to its easy availability through the objective data from a sample of acutely poisoned patients admitted to NECTR in Cairo. Management of cases is mainly supportive as there is no specific antidote, causing high mortality rate. Early arrival and proper decontamination, resuscitation, intensive monitoring and supportive therapy may result in good outcome.

Keywords


Aluminium Phosphide (ALP), Blood Lactate Level, Mortality, Phosphine Gas, Prediction.

References





DOI: https://doi.org/10.18311/ti%2F2018%2Fv25i4%2F23804