Clinical characteristics and follow-up analysis of 12 patients of acute phosphine poisoning / 中华劳动卫生职业病杂志

Objective: To investigate the clinical characteristics of patients with acute phosphine poisoning, and to follow up and evaluate the prognosis of patients. Methods: In May 2022, 12 patients with phosphine poisoning by respiratory inhalation in Beijing Chao-Yang Hospital of Capital Medical University were analyzed. The patients were treated with symptomatic support therapy. Three months later, patients were re-evaluated the symptoms of poisoning, pulmonary function and magnetic resonance imaging (MRI) of the brain to understand the prognosis of the phosphine poisoning. Results: The main symptoms of 12 patients were respiratory and central nervous system symptoms with hypoxia. The symptoms of poisoning improved after treatment. Follow-up found that the patients had different degrees of residual symptoms. Pulmonary function showed increased airway resistance. Airway challenge test was positive in some patients. MRI of the head of some patients showed small ischemic focus in bilateral frontal lobes. Conclusion: Acute phosphine poisoning may cause persistent damage to the respiratory system and central system, and residual symptoms after 3 months.

Analysis of the Distribution of Total Phosphine and the Characteristics of Phosphine Poisoning in 29 Victims / 法医学杂志

OBJECTIVES@#To study the distribution of total phosphine in phosphine poisoning victims and summarize the characteristics of phosphine poisoning cases.@*METHODS@#The phosphine and its metabolites in the biological samples of 29 victims in 16 phosphine poisoning cases were qualified and quantified by headspace gas chromatography-mass spectrometry.@*RESULTS@#Five victims among 29 were poisoned by ingestion of aluminium phosphide and 24 by inhalation of phosphine gas. Phosphine metabolites were detected in the biological samples of 23 victims, and the concentrations of total phosphine in blood ranged 0.5-34.0 μg/mL. The total concentration of phosphine in liver tissue was up to 71.0 μg/g. Phosphine was not detected in the blood of the other six survived victims, which may be related to the small amount of phosphine exposure and the delay in blood sampling.@*CONCLUSIONS@#The total concentration of phosphine in blood and tissues caused by aluminum phosphine ingestion is higher than that caused by phosphine gas inhalation. The death cases of phosphine inhalation are characterized by long exposure time, repeated exposures and age susceptibility.

A retrospective study of clinical profile and outcome of patients with rodenticide poisoning in tertiary care teaching hospital, Mandya, Karnataka, India

Background: Poisoning is the major health problem in developing countries like India. Rodenticides are one of the commonest substances used for poisoning in India. Rodenticides are the substances used to kill rats. They differs from chemical composition and toxicity profile. Prognosis mainly depends on chemical content of poison.Methods: This retrospective record-based study was conducted between October 2018 to September 2019 at MIMS tertiary care teaching hospital, Mandya, Karnataka, India. Data regarding age, sex, marital status, occupation, socioeconomic status, type of poison, route of exposure, clinical presentation, complications and outcome of poisoning and associated comorbid conditions were collected from the hospital records and documented in the pre-structured proforma. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: Out of 126 study subjects, 77 (61.11%) were female, 49 (38.89%) were male. Most common age group was 21 to 30 years (45.23%), followed by 31 to 40 years (26.19%) group. Most common poison was zinc phosphide (52.39%), followed by yellow phosphorous (30.16%). Mode of poisoning was suicidal (94.4%) followed by accidental (5.6%).Most common symptom at presentation was nausea, vomiting (62.6%) followed by pain abdomen (52.4%).Most common complication was hepatitis 34 (26.98%) patients, followed by hepatic encephalopathy in 6 (4.76%) and cardiogenic shock in 6 (4.76%) patients. Total mortality was 8 (6.3%).Conclusions: Among rodenticides zinc phosphide was most common consumed poison in present study. Yellow phosphorous was most toxic poison and Aluminium phosphide was most lethal poison. Even though there is no specific antidote, early symptomatic treatment is the key in reducing the mortality.

Study of impact of clinical and biochemical parameters in aluminium phosphide poisoning

Background: The aim of the study was to assess the relationship between clinical and biochemical parameters with outcome of aluminium phosphide toxicity.Methods: Total 46 patients with aluminium phosphide poisoning admitted to the Hospitals attached to BMCRI between November 2018 and April 2019 were prospectively studied. After adequate history was obtained and immediate first aid measures given, clinical and biochemical parameters such as liver enzymes, serum creatinine, serum potassium and magnesium levels were studied. The patients were then followed up until outcome. Data was analysed using Descriptive statistics like mean, Standard deviation and percentages were calculated. Inferential statistics like Mann-Whitney test was used to compare the parameters between the two outcome groups (discharged and death) using SPSS software.Results: Among the study population, between the two outcome groups males were 80.6% and females were 19.4%. the outcome was death in 10 patients and 36 patients were discharged. Tachycardia and hypoxia at presentation, Low Serum Magnesium and higher levels of serum creatinine at admission were found to be associated with higher mortality in patients with aluminum phosphide toxicity and were statistically significant.Conclusions: These clinical and laboratory parameters can be considered as manifestation of hemodynamic compromise and are hence associated with poorer prognosis. Serum magnesium levels, can be used in prognostication of aluminium phosphide toxicity, owing probably to their effects of cardiotoxicity. Increased serum creatinine levels as a result of acute kidney injury, could also indirectly point to circulatory compromise. Hence these clinical and laboratory parameters at presentation have important implications.

Aluminium phosphide induced pancreatitis

Aluminium Phosphide (AlP) is a commonly used agricultural pesticide. It is cheap, effective, and easily available. Aluminium Phosphide is used as a rodenticide, insecticide, and fumigant to preserve stored cereal grains, also known as "Wheat pills". In Iran, it is known as the rice tablet. There, have been frequent incidents of accidental or intentional deaths. There have been only a few case reports on aluminum phosphide-induced pancreatitis in the literature available. In this report, we present the case of a young man who developed acute pancreatitis following ingestion of aluminum phosphide pellet in the absence of the usual risk factors and after exclusion of other possible causes of pancreatitis. 35-year-old male came to the ER of SGT Hospital, Gurugram, one hour after ingestion of a single 3 g tablet of Aluminium Phosphide (Celphos) at home, with a suicidal intent. He had three episodes of Vomiting on the way to the hospital. On Day 1 of admission, USG abdomen showed heterogeneity of head and the body of pancreas with minimal peri-pancreatic fluid, suggestive of Pancreatitis. Serum Amylase and lipase levels were raised throughout the hospital course. CT images were suggestive of pancreatitis. The signs and symptoms of Acute AlP Poisoning are non-specific, dose dependent and evolve with time. After ingestion, toxic features usually develop within a few minutes. The major lethal consequence of AlP ingestion is profound circulatory collapse, secondary to direct effects of toxins on cardiomyocytes, fluid loss, and adrenal gland damage. Our patient was diagnosed with acute pancreatitis in first 24hours of admission with high suspicion of pancreatitis and managed well with iv fluids and supportive treatment and was discharged after 3 weeks of in hospital stay.

A study on outcome of rodenticide poisoning patients admitted to a tertiary care teaching hospital in relation to the chemical content of that poison

Background: Poisoning is the major health problem in India. Rodenticides are the commonest poisoning in Asian countries like India. Rodenticides are the substance used to kill rats. Prognosis mainly depends on chemical content of poison.Methods: This retrospective record-based study was conducted between January 2017 to December 2017 at government hospital department of general medicine, MIMS, Mandya, Bangalore, Karnataka, India. Data regarding age, sex, marital status, occupation, type of poison, route of exposure, and outcome of poisoning and associated co-morbid conditions were collected from the hospital records and documented in the pre-structured proforma. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: Out of 56 patients 33 (59%) were female 23 (41%) were male. Most common age group was 20 to 30 years, followed by 31 to 40 years group. Most common poison was yellow phosphorous (41%), followed by aluminium phosphide (29%). Most common complication was hepatitis (20%),followed by cardiogenic shock (9%).Total mortality was 3 (5%).Conclusions: Among rodenticides yellow phosphorous was most common consumed poison in present study. Aluminium phosphorus was most lethal poison. Even though there is no specific antidote, early symptomatic treatment is the key in reducing the mortality.

A case report of aluminium phosphide poisoning

Aluminium phosphide (ALP) is highly toxic and poisoning can result in high mortality rates. A 26-year-old female who allegedly ingested a toxic dose of ALP presented with vomiting and diarrhoea. She developed cardiac arrest with refractory pulseless ventricular tachycardia. Despite aggressive resuscitation, she succumbed to death seven hours following ingestion. In cases like this, a better outcome can be achieved with early arrival, prompt diagnosis, aggressive resuscitation and intensive monitoring.

Near Fatal Accidental Organophosphate and Phosphine Poisoning Of a Family of Eight: Case Report.

We describe a near fatal poisoning in a family of eight caused by accidental ingestion of Aluminium Phosphide (A1P) and Dichlorvos (DDVP), common and readily available pesticides used to kill rodents and insects in stored farm products. Management challenges in a rural hospital, where most accidental agricultural based poisoning cases are likely to present are also discussed.

Serie de casos de intoxicación fatal por ingesta intencional de fosfuro de aluminio: case reports with fatal evolution / Aluminium phosphide poisonings: case reports with fatal evolution

El fosfuro de aluminio (AlP) es un plaguicida fumigante de bajo costo, cuyo único uso permitido es el control de plagas en granos almacenados. En contacto con la humedad del aire libera gas fosfina (PH3), altamente tóxico, inflamable y explosivo, pero que se disipa rápidamente. En todas las presentaciones, 3 g de la formulación genera 1 g de gas fosfina. La exposición a 1000 ppm durante 30 minutos es fatal. Presentamos una serie de casos de intoxicación severa por ingesta intencional de fosfuro de aluminio, con desenlace fatal, con el objetivo de asesorar e informar sobre los mecanismos de intoxicación y el manejo adecuado del paciente intoxicado.

Aluminium phosphide (AlP) is a fumigant pesticide inexpensive; whose only permitted use is for stored grain pest control. On contact with moisty air, it releases phosphine gas (PH3), highly toxic, flammable and explosive, but that quickly dissipates. For all presentations, a 3 g formulation generates 1 g of phosphine gas. Exposure to 1000 ppm for 30 minutes is lethal. We present a series of cases of severe poisoning with AlP, in order to advise and inform on the mechanisms of toxicity and proper management of the poisoned patient.

Aluminium Phosphide Poisoning.

Aluminium phosphide poisoning is a major cause of morbidity and mortality in northwest and central India. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. The mechanism of toxicity includes cellular hypoxia due to the effect on mitochondria, inhibition of cytochrome C oxidase and formation of highly reactive hydroxyl radicals. In India, most of the patients who come with Celphos poisoning succumb to its toxicity because of the considerable time gap between the ingestion of the poison and the initiation of proper treatment. This has led to widely prevalent scepticism among physicians while managing cases of Celphos poisoning. Due to no known specific antidote, management remains primarily supportive care. In most of the studies, poor prognostic factors were presence of acidosis and shock. The overall outcome improved in the last decade due to better and advanced intensive care management.

Profile of poisoning cases in a Tertiary care Hospital, Tamil Nadu, India.

Poisoning is an important public health problem causing significant morbidity and mortality throughout the world. Information available with regard to acute poisoning in adults is limited at Salem, Tamil Nadu. Hence this study was done with the above objective. It is a retrospective study conducted during Jan 2009-Jan 2012 in a tertiary care hospital. 150 cases of acute poisoning in adults due to drugs and chemicals were included. Data on age, sex, marital status, occupation, religion, locality, type of poison, time and month of intake, route of exposure, associated co-morbid conditions and outcome of poisoning were recorded and analyzed by descriptive method. Among 150 cases, 148 cases were of intentional poisoning and two cases were of accidental poisoning. In all the cases the route of exposure was oral. Males (92 cases) outnumbered females (58 cases) and 101 cases were married. Peak occurrence was in the age group of 21-30 years (47 cases). Occupation wise poisoning was commonly found among male laborers (18.66%) and farmers (13.33%) followed by house wives (28%) and students (16.66%). 147 cases (98%) were Hindus. More cases were reported during summer season (36%) and day time (80%). Organophosphorus was the commonest agent (58.66%). Associated co-morbid conditions were found in 16 cases. The incidence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies.

Sociodemographic and clinical profile of aluminium phosphide poisoning in Jaipur, Rajasthan.

Aluminium phosphide pellets are inexpensive and widely available for grain fumigation and preservation. Their free availability has led to an epidemic-like situation in some parts of India due to its intentional (suicidal or homicidal) or accidental ingestion. There is a steady year-wise increment in the number of deaths due to this poison, and it is the single most frequent suicidal agent in Jaipur, Rajasthan. Eighty nine patients with acute aluminium phosphide poisoning were studied in SMS Hospital Jaipur, during the period September 2009 to September 2010. Out of these, 74 patients died (83.15%). The sociodemographic and clinical profile of aluminium phosphide poisoning are discussed in this paper.

The study of aluminium phosphide poisoning in a Tertiary Care Hospital - Amritsar.

Trend of poisoning had been constantly changing throughout the world, as the advent of new agents, has always replaced the older one due to their innumerable merits and demerits. Similarly in India, the pattern of ingested poisons has also changed. A number of chemical substances which are developed to save the agricultural product from rodents and pests are in fact themselves proving to be disastrous for mankind. Recently in the last two decades aluminium phosphide [Alphos] used as pesticide, rodenticide, fumigant for storage of food grains has created havoc with the human lives differently i.e. suicidal, accidental and very rarely homicidal poisoning agent. Alphos, a solid fumigant used for storage of food grains, freely accessible in the market is commonly used suicidal agent with high mortality rate as no antidote or specific treatment is available. The present study of 50 cases of aluminium phosphide poisoning showed male dominance, common in sikhs and educated persons. Heart is the first organ to be affected. Shock was present in majority of cases. Sufficient time was available for recording dying declaration.

Forensic view on aluminium phosphide poisoning.

In India, acute aluminium phosphide poisoning (AAlPP) is a serious health care problem. This study aimed to determine the characteristics of AAlPP and the predictors of mortality at the time of patients' admission. We studied consecutive admissions of patients with AAlPP admitted to the intensive care unit (ICU). We noted 38 parameters at admission to the hospital and the ICU and compared survivor and non-survivor groups. A total of 54 patients were enrolled comprising 10 females and 44 males and the mean ingested dose of poison was 0.75 ± 0.745 grams. The mortality from AAlPP was 59.3%. We found the following factors to be associated with an increased risk of mortality: a serum creatinine concentration of more than 1.0 mg % (P = 0.01), pH value less than 7.2 (P = 0.014), serum bicarbonate value less than 15 mmol/L (P = 0.048), need for mechanical ventilation (P = 0.045), need for vasoactive drugs like dobutamine (P = 0.027) and nor adrenaline (P = 0.048) AAlPP causes high mortality primarily due to early haemodynamic failure and multi-organ dysfunction.

Aluminium phosphide poisoning: management and prevention.

Death by Aluminium phosphide (AIP) and organo-phosphide poisoning are the commonest forms of poisoning in India. Aluminium phosphide is used as rodenticide and pesticide in grain storage facilities. It produces phosphine gas, which results in mitochondrial poisoning. There is no known antidote for AIP poisoning. The effects of AIP poisoning, mediated by phosphine and mechanism of action have not been established.The information related to this poisoning is available in the literature and substantiated by practical experience. Liberated phosphine cannot be detoxified but Magnesium sulphate has been reported to be effective. Another remedy can be rapid absorption by coconut oil which might be helpful. Treatment consists of gastric lavage with potassium permanganate solution, oral administration of charcoal and sorbitol suspension, intravenous administration of sodium bicarbonate, magnesium sulphate and calcium gluconate, and oral administration of sodium bicarbonate and coconut oil. Use of coconut oil for treatment in this poisoning is suggested, although clinical trials and scientific approval is still awaited. Every suggestion, news regarding new modality of treatment for this poisoning needs to be shared in the interest of saving precious human lives. It is with this aim the present paper is written.

Altered glucose homeostasis in response to aluminium phosphide induced cellular oxygen deficit in rat.

The present study was designed to analyze the effect of acute aluminium phosphide (ALP) (10 mg/kg body wt.) exposure on the glucose homeostasis in rat liver and brain. ALP has been implicated in the inhibition of cytochrome oxidase causing reduced oxygen uptake and decreased ATP synthesis eventually resulting in cellular energy crisis. A significant decrease in plasma glucose levels in the ALP treated rats has been observed. Therefore, decreased ATP levels coupled with hypoglycemia may further intensify the cellular energy deficits. In order to meet the sudden increase in the local energy demand, the brain tissue utilizes its stored energy in the form of glycogen breakdown as observed by a decrease in the glycogen levels in both liver and brain which was accompanied by a marked increase in the activity of glycogen phosphorylase in both the tissues. The glycolytic rate was found to be enhanced in brain tissue as evident by increased activities of hexokinase and phosphofructokinase enzymes, but decreased in liver of ALP treated rats. Lactate levels were increased in plasma and brain, but decreased in liver of ALP treated rats. Pyruvate levels increased in the plasma and liver, but no change was observed in the brain tissue. ALP did not cause any change in the gluconeogenic enzymes like glucose-6-phosphatase and fructose-1,6-bisphophatase in brain, but a significant increase was observed in the liver. Results of the study showed that ALP induced cellular energy deficit leads to compromised energy status of liver and brain coupled with substantial alterations in glucose homeostasis. However, the activity of glucose-6-phosphate dehydrogenase decreased significantly in both the tissues.

Trends of poisoning in Faridkot region of Punjab- A retrospective study of one year.

Since immemorial times, poisonous substances have been reported to be adversely affecting human life, both in terms of morbidity and mortality. Evolution in fields like agriculture, industry etc has made wide and easy availability of various poisonous substances. The present study is a retrospective study of one year which is related to poisoning cases that were admitted in the emergency department of G.G. S. Medical College, Faridkot from 1st January 1996 to 31st December 1996. The analysis of the data revealed that out of 78 patients admitted in the hospital, 31 patients died. The maxi-mum incidence was seen in the age group of 21-30 years with males outnumbering the females. The commonest poison used was organophosphorus group of compounds.

Aluminium phosphide fatalities: A 24 years experience.

A 24 years autopsy study (1982-2006) of acute poisoning deaths owing to aluminium phosphide from a tertiary care hospital of Northern India (Postgraduate Institute of Medical Education and Research, Chandigarh revealed that mortality due to acute poisoning constitued 12.6% of the total unnatural fatalities and out of which 51.3% were because of this fumigant insecticide. The first victim reported in 1982 and its proportion, which was 20% in years 1982 to 86, increased to 73% between the years 1994-98 and then decreased to 49% of the total acute poisoning fatalities in 2002-06. Peak incidence was observed in the age group of 21-25 years (31%) and least in the age group of beyond 65 years (3%). The proportion of suicidal deaths increased from 20% to 54% between these periods. Sales workers / businessmen (15%), office workers (10.7%) followed by student (10.4%), among the males and domestic workers (23%), students (10.4%) in females were the main victims of suicidal poisoning. 53% male victims were married where as 59.4% female victims were unmarried. 52.4% were from the urban areas.

Homicidal aluminium phosphide poisoning.

Dead body of a female was brought for postmortem examination at the mortuary of New Civil Hospital, Surat. History revealed that her husband had given three tablets to her on the pretext that these tablets would help in the birth of a male child. She became ill soon after consuming the tablets and died within 12 hours of ingestion while under treatment. Autopsy revealed death from aluminium phosphide poisoning. This unusual case is presented here.

Aluminium phosphide poisoning autopsy findings.

At prospective study to observe the gross and histopathological findings in Aluminium Phosphide Poisoning was undertaken on medicolegal autopsy cases brought to the department of Forensic Medicine. Gandhi Medical College, Bhopal. The study was undertaken, as Aluminium Phosphide Poisoning has become the commonest poisoning in central India over the last few years. 50 chemically confirmed autopsy cases were included in the present study and were examined grossly in detail and samples of tissue from various organs were stained by haemotoxylin eosin and observed microscopically. Several gross autopsy findings have been observed and are included in this paper. The present study is the largest autopsy series reported on Aluminum Phosphide, which includes the histopathological findings of various organs. and observations made earlier by the workers have also been compared.