Recent Advances in Management of Aluminium Phosphide Poisoning

Abstract

Abstract Compounds containing phosphide used as rodenticide are among most fatal poisonings encountered in Poisoning Control Center, Ain Shams University Hospitals (PCCA) Cairo, Egypt. Its toxicity is associated with challenging oxidative damaging effects that involve all tissue cells. Patients develop severe hypotension and metabolic acidosis. No available data about specific antidotes for these compounds, however we assume that antioxidants may play a beneficial role in improving intoxicated patient outcome. N-acetyl cysteine (NAC) is supposed to have a protective role. Objective To evaluate the role of antioxidant N- acetyl cysteine in improving outcome of phosphide intoxicated patients. Methods The study is double blind randomized clinical trial, carried on patients presented to PCCA over 3 years period (2015-2017) with sever zinc and aluminum phosphide intoxication. They are randomly classified to NAC treated group (receiving conventional treatment plus NAC intravenous (IV) infusion in a dose of 300mg/kg over 20hours then 150mg/kgm/day until improvement) and placebo group (receiving conventional treatment plus saline IV infusion). Clinical data such as(age, sex, mode of poisoning and vital data), blood PH, liver function test, ECG, usage of mechanical ventilation, mortality and period of stay were recorded and compared for each group. Results statistical analysis revealed significant decrease in mortality and mechanical ventilation in patients with the group of NAC administer. However no significant difference was observed regarding period of stay. Conclusion The study concluded that NAC may have good role in decreasing mortality and incidence of mechanical ventilation in phosphide poisoning patients.