Prognostic Significance of Blood Glucose Levels and Alterations Among Patients with Aluminium Phosphide Poisoning.

OBJECTIVES: This study aimed to assess the prognostic significance of blood glucose levels and blood glucose alterations (i.e. hyper- or hypoglycaemia) among patients with aluminium phosphide (AlP) poisoning. METHODS: This prospective observational study was conducted at the Postgraduate Institute of Medical Education & Research, Chandigarh, India, between January 2010 and June 2011. All patients presenting to the emergency department with a definitive history of AlP ingestion or symptoms compatible with AlP poisoning were included in the study. Blood glucose levels were recorded at presentation and every six hours thereafter. Alterations in blood glucose levels and other clinical and laboratory variables were subsequently compared between survivors and non-survivors. RESULTS: A total of 116 patients with AlP poisoning were identified. Of these, 57 patients (49%) survived and 59 patients (51%) died. At presentation, the mean blood glucose levels of survivors and non-survivors were 119.9 ± 35.7 mg/dL and 159.7 ± 92.5 mg/dL, respectively (P <0.001). In comparison to the survivors, non-survivors had significantly higher heart rates, total leukocyte counts, blood glucose level alterations and serum creatinine levels (P <0.050). In addition, systolic blood pressure, Glasgow coma scale scores, arterial blood gas pH and bicarbonate values and duration of hospital stay was significantly lower compared to survivors (P <0.001). However, neither blood glucose levels at admission nor blood glucose alterations correlated independently with mortality in a multivariate analysis. CONCLUSION: The role of blood glucose level alterations in predicting patient outcomes in AlP poisoning cases remains inconclusive. Further studies with larger sample sizes are required.

Effect of aluminium phosphide exposure on kinetic properties of cytochrome oxidase and mitochondrial energy metabolism in rat brain.

This study involves the effect of aluminium phosphide exposure on the kinetic characteristics of cytochrome oxidase and the mitochondrial respiratory chain function in rat brain. Mitochondrial preparations from both control and aluminium phosphide-treated rats demonstrated significant decrease in the maximal activity of cytochrome oxidase (approximately 50%) when expressed per unit membrane protein and on a turnover number basis (nmol/min/nmol haem a). The results indicated that there was a decrease in the catalytic efficiency of the active oxidase molecules on aluminium phosphide treatment. Arrhenius plot characteristics differ for cytochrome oxidase activity in mitochondria isolated from treated and control rats, in the break point of the biphasic plot which was shifted to a higher temperature. The decreased activity of cytochrome oxidase along with altered NADH and succinic dehydrogenase activities might have contributed towards a significant decline in state 3 and state 4 respiration. These alterations in the electron transport chain complexes in turn affected the ATP synthesis rate adversely in the mitochondria, isolated from treated rats. The data reflect the interaction of aluminium phosphide with redox chain components leading to the impairment of the electron transfer along the respiratory chain.